Antidepressants — cross-table viva

Station structure

Time: 8–10 minutes. Depth: consultant teaching registrar. Expect mechanism maps, trial one-liners, dose ranges, and safety without marketing slogans.[2]

Core questions and model points

1. Map classes to targets. SSRI→SERT; SNRI→SERT+NET; bupropion→NET/DAT; mirtazapine→α2/5-HT2/3; TCA→mixed + anticholinergic/Na channel; MAOI→MAO inhibition.[2]

2. STAR*D in 30 seconds. Measurement-based sequential steps; ~30% remit step 1 framing; cumulative remission falls across steps; switch options after SSRI failure roughly comparable among studied agents; lithium/T3 and late MAOI/combo pathways exist.[1]

3. Cipriani 2018 one-liner. All 21 antidepressants beat placebo; efficacy/acceptability ranks differ modestly — shared decision, not a single winner for all patients.[2]

4. Serotonin toxicity. Clinical diagnosis; Hunter criteria; stop serotonergic drugs; support; distinguish from NMS.[3][4]

5. Augmentation. Lithium meta-analytic support; atypical AP meta-analytic support with metabolic cost; name monitoring for each.[5][6]

6. Maintenance. Continuation prevents relapse (Geddes).[7]

7. Sexual SE and hyponatraemia. High sexual dysfunction incidence (Montejo); antidepressant–hyponatraemia association especially elderly (Movig).[8][9]

Discriminators examiners reward

States fluoxetine long washout before MAOI rather than “any SSRI is the same”; names remission as goal, not mere response; links young adult early-treatment weeks to closer review without claiming medicines “cause suicide” as a universal absolute.[1][4][8]

Common fails

Combining MAOI with SSRI casually; claiming SSRIs have no sexual side-effects; unable to name any augmenter with evidence; confusing discontinuation syndrome with mania without differential thinking.[4][5][8]