6 - Depression Flashcards
How long do you need to treat for once in remission?
6-9 months
if severe, recurrent, chronic, etc. then do 2 years treatment
Non-pharms?
therapy, exercise
For pharmacologic treatment:
Min therapeutic dose should be reached in first ___ weeks of treatment and then increase if necessary over the next 4-6 weeks
2
side effects of SSRIs
GI, CNS, sexual dysfunction
*sexual dysfunction is more likely to stay all throughout treatment, while GI and CNS side effects will improve
At high doses of venlafaxine, what can happen?
can increase BP @ doses > 225 mg/day
*monitor BP and avoid in those with uncontrolled HTN
What is the active metabolite of venlafaxine?
desvenlafaxine
Bupropion also used for ?
also used for smoking cessation
who is bupropion CI in ?
- those with history of or current anorexia or bulimia
- those with history of or current seizure disorder
s/e of bupropion
- less GI disturbance compared to SSRIs
- no sexual s/e
Bupropion + _____ decreases seizure threshold
alcohol
s/e of mirtazapine?
- sedation and weight gain
* less risk of GI and sexual s/e
Avoid irreversible MAOis with _____ containing foods
tyramine
*cheese, meats, ripe fruit
Washout period:
Irreversible MAOi to any other antidepressant
2 weeks
Washout period:
Any other antidepressant to irreversible MAOi
5 half lives
Washout period:
From moclobemide to any other antidepressant
5 day washout
Washout period:
Fluoxetine to an irreversible MAOi
5 weeks
Can also use _____ for depression
antipsychotics
Which NHPs are proven effective for mild depression?
- St. John’s Wort
- SAM-e
*both can increase risk for serotonin syndrome when used with other serotonergic meds
Choice for depression in pregnancy?
- SSRIs
* not paroxetine
Choice for depression in breastfeeding?
sertraline, escitalopram or citalopram
*paroxetine and sertraline are detected in low amounts in breast milk
When do you assess for remission?
6-8 weeks after they are at therapeutic dose
