QuestionSBA
QuestionChoice
Citalopram is not a tricyclic antidepressant. It is a selective serotonin reuptake inhibitor (SSRI) that works by increasing the serotonin levels in the brain. An increase in serotonin level has been shown to bring about an improvement in symptoms
34126
b
Citalopram is a tricyclic antidepressant that works by increasing levels of adrenaline in the brain
QuestionChoice
If a patient has been feeling better for 6 months or more, he/she might be suggested to come off citalopram. However, patients should be reminded to discuss with their doctors before stopping the medication because abrupt discontinuation could lead to discontinuation symptoms such as restlessness and irritability. Dose of citalopram should be tapered and reduced gradually over 4 weeks
34125
a
She should not abruptly discontinue her medication when she is feeling better
QuestionChoice
Citalopram is generally safe to be used during breastfeeding. Citalopram usually only passes into breast milk in small quantities and has only been associated with adverse effects in very few breastfed babies. Moreover, grey baby syndrome is more commonly linked with antibiotic chloramphenicol
34127
c
She should not breastfeed if she is taking citalopram because citalopram passes into breast milk in large quantities and can lead to grey baby syndrome
QuestionChoice
Citalopram is not a tricyclic antidepressant. It is a selective serotonin reuptake inhibitor (SSRI) that works by increasing the serotonin levels in the brain. An increase in serotonin level has been shown to bring about an improvement in symptoms
34128
d
Citalopram can lead to addiction
QuestionChoice
Agitation and sweating are not normal side effects of citalopram. Patients should stop taking the medication and seek immediate medical help because these signs are suggestive of serotonin syndrome
34129
e
It is normal to experience agitation and sweating during the course of treatment
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

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2769
SSRI considerations
Topic
90
Psychiatry
She should not abruptly discontinue her medication when she is feeling better
6836
A 30-year-old woman presents to her GP with a 3-week history of depression, hopelessness, fatigue, poor appetite, and difficulty sleeping. She recently gave birth to her first child a month ago. She denies hallucinations or thoughts of harming her baby. Her Edinburgh Postnatal Depression Scale score is 8/30.

Physical examination: HS 1+11 + 0, chest clear with no added lung sounds, abdomen SNT, normal neurological exam
PMH, DH: NIL
The patient is advised to commence treatment with citalopram 20mg PO once daily along with cognitive behavioural therapy and attend another appointment in two weeks’ time to review the medication.


Question: Select the most important information that should be provided for this patient.
a