69 - depression (ott) Flashcards
Risk of Recurrence
1 episode: ___ - ___ %
2 episodes: ___ %
3 episodes: ___ %
50-60%
70%
90%
risk factors for depression
- female sex
- middle age
- single
- white
- low economic status
- unemployment
- physical disability
- lack of social support
- stressful life events/adverse childhood experiences
- prior episodes or suicide attempts
- co-morbid medical disorders
- co-morbid substance use disorder
disease course
occurs at any age, but commonly seen in early adulthood ___ - ___ s
symptoms develop over ___ to ___
usually see a response to treatment, but not aggressive enough to achieve ___
remission = a period of __ or more months with no symptoms or only __ - __ symptoms
- remission is possible and is the treatment goal
- 20-30
- days, weeks
- remission
- 2, 1-2
Recurrence
- risk becomes lower overtime as duration of ___ increases
- persistent mild symtpms during remission is a predictor of ___
- function ___ during the episode and goes back to baseline upon remission
- remission
- recurrence
- deteriorates
DSM-5 Diagnostic Criteria
at least one of the symptoms must be ___ mood or loss of ___ or pleasure in doing things
- symptoms must cause clinically significant impairment in functioning
- no history of ___
- not attributed to the psychological effects of a ___ or another condition
- depressed
- interest
- mania
- substance
DSM-5 Diagnostic Criteria Mnemonic
SIGE CAPS
- sleep (insomnia/hypersomnia)
- interest decreased
- guilt/worthlessness
- energy loss/fatigue
- concentration difficulties
- appetite change
- psychomotor agitation/retardation
- suicidal ideation
depression specifiers
with anxious distress
- higher ___ risk
- longer duration of illness
- ___ treatment response
with melancholic features
- anhedonia
- psychomotor ___ /agitation worse in the ___ , more likely in ___
with atypical features
- ___ mood
- weight ___
- hypersomnia, more likely in ___ patients
- suicide
- poor
- retardation, elderly
- reactive
- gain
- younger
depression specifiers
with psychosis
- hallucinations/delusions
- may or may not be congruent with ___
with catatonia
- stupor, blunt affect, extreme ___ , negativism, psychomotor ___ , posturing, echolalia
with peripartum onset
- occurs during pregnancy or ___ weeks following birth
with seasonal pattern
- symptoms have a relationship to the time of the year (fall/winter) and remit in the spring
- mood
- withdrawals, retardation
- 4
self administered rating scales
- depression: ___
- depression (clinical trials): ___
- bipolar: ___
- (PHQ9) - patient health questionnaire
- (QIDS-R-16) - quick inventory of depressive symptomatology self report
- (MDQ) - mood disorder questionnaire
goals of treatment
1) reduced or eliminate s/s of depression
2) restore ___ and psychosocial functioning to baseline
3) reduce the risk of ___ and recurrence
4) reduce the risk of harmful consequences ( ___ ideation)
- occupational
- relapse
- suicidal
phases of treatment
acute:
- __ - __ weeks or remission of symptoms
- Goal: induce ___
continuation:
- __ - __ additional months, recommended for all patients
- Goal: prevent ___
maintenance:
- patient-specific ___
- often indefinite treatment if ___ or greater major depressive episodes
- Goal: prevent ___
- 6-12
- remission
- 4-9
- relapse
- duration
- 3
- recurrence
SSRIs
___ (Lexapro)
dose range: 5-10 mg/day
clinical pearls
- pure S enantiomer of citalopram
- substrate of ___
escitalopram
- 2C19
Risk of Suicidality
boxed warning for suicidaily in ___ antidepressant medications (for patients less than or equal to ___ years of age)
- decreased risk in those __ and onlder
closely monitor for increased ___ and changes in behavior during the first 1-2 months of therapy and after any dose changes
- ALL, 24
- 65
- suicidality
SSRIs
___ (Celexa)
dose range: 10-40 mg/day
- > 60 years: do not exceed 20 mg
clinical pearls
- dose dependent ___ prolongation
- substrate of ___ and ___
citalopram
- QTc
- 2C19 and 3A4
SSRIs
___ (Prozac)
dosage range: 10-80 mg/day
clinical pearls:
- weekly DR oral formulation (90 mg/week)
- ___ t 1/2 (96-144 hrs)
- activating potential
- ___ and ___ inhibitor (norfluoxetine) - active
flucoxetine
long
CYP 2D6, 3A4
SSRIs
___ (Luvox)
dosage range: 50-300 mg/day
clinical pearls
- indicated for ___ treatment
- inhibitor of ___ and ___
fluvoxamine
- OCD
- 1A2, 2C19
not super common
SSRIs
___ (Paxil)
dosage range:
- 10-60 mg/day
- 12.5-75 mg/day
clinical pearls
- must ___ due to ___ effects
- weight ___, sedation
- ___ wall defect risk to fetus
- inhibits ___ and ____
paroxetine
- taper, anticholinergic
- gain
- septal
- 2D6, 2B6
Ott doesnt like this drug (hard to stop)
SSRIs
___ (Zoloft)
dosage range: 25-200 mg/day
clinical pearls
- more ___ upset than other antidepressants
- inhibitor of ___ , ___ , and ___
sertraline
- GI
- 2C19, 2D6, 3A4
SSRIs - Adverse Effects/Key Points
- onset of action in __ - ___ weeks
- full dose response in ___ - ___ weeks
AE
- variable sedation
- weight gain ( ___ )
- weight loss ( ___ )
- increased ___ risk ( ___ inhibition)
- hypo ___ (especially in elderly)
- ___ dysfunction
- anxiety/agitation (upon initiation)
- emotional blunting
- decreased ___ mineral density
- 1-2
- 4-6
- paroxetine
- fluoxetine
- bleeding, platelet
- hyponatremia
- sexual
serotonin sydrome
medical ___ due to excessive amounts of serotonin in the CNS
may be caused by:
- overdose
- combined use of serotonergic drugs
- drug inteactions
serotonergic agents
- Li
- serotonergic antidepressants
- buspirone
- linezolid
- amphetamines
- dextromethorphan
- triptans
- st john’s wort
- tramadol
- fentanyl
- cocaine
- LSD
emergency
serotonin syndrome - treatment
___ the offending agent + supportive care
potentially could use serotonin blockers
- ___ (variable efficacy)
70% of patients recover within 24 hours
stop
cyproheptadine
steps to manage depression
