Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 - Clinical (Winter) > 8 - Depressive Disorders > Flashcards

8 - Depressive Disorders Flashcards

1
Q

Major depression sx

A

D SIG E CAPS

  • Depressive mood
  • Sleep (decreased > increased)
  • Interest decreased (anhedonia)
  • Guilt/worthlessness increased
  • Energy (decreased > increased)
  • Concentration decreased
  • Appetite/weight (decreased > increased)
  • Psychomotor (decreased > increased)
  • Suicide/thoughts of death increased
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Major depression – DSM IVR criteria for diagnosis

A
  • Presence of sx for > 2 weeks
  • At least 5 sx present; at least 1 depressed mood or loss of interest/ pleasure
  • Sx occur nearly every day
  • Sx cause significant distress or impairment of functioning
  • Sx not due to bereavement or last > 2 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Additional sx of depression

A
  • Emotional – anxiety, irritability
  • Cognitive – decreased concentration, indecisiveness, poor memory
  • Psychotic – bizarre behaviour, hallucination, delusions
  • Physical – fatigue, decreased libido, decreased hygiene, crying spells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Secondary depression causes

A
  • Medical disorders – thyroid disorder, malignancy, stroke, CHF/ MI, Parkinson’s
  • Psychiatric disorders – alcoholism, schizophrenia, anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Non-pharms for depression

A
  • Cognitive behavioural therapy
    • Change distorted thinking
    • Alteration of target thoughts
    • Change erroneous assumptions
    • Promote self-control over thinking
  • Interpersonal
  • Bright light therapy – for seasonal affective disorder
  • Exercise & good nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Major depression – time course

A
  • Most last 6-24 months
  • > 2 years in 5-10%
  • Often recurrent episodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tx goals for depression

A
  • Shorten episode
  • Decrease sx (response)
  • Restore function
  • Eliminate sx (remission)
  • Prevent relapse
  • Minimize adverse effects of tx
  • Minimize drug interactions
  • Promote adherence to therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What determines the urgency of tx for depression

A
  • Severity of depressive sx
  • Severity in impairment of functioning
  • Psychotic sx
  • Suicidal thoughts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Typical response for anxiety and insomnia to antidepressants

A

Few days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Typical response for energy and somatic sx to antidepressants

A

2nd or 3rd week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Typical response for sleep patterns to antidepressants

A

Several weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Typical response for depressed mood and sexual dysfunction to antidepressants

A

4th week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MOA of SSRIs

A

Increase 5-HT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MOA of SNRIs

A

Increase 5-HT and NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOA of NDRIs (norepinephrine dopamine reuptake inhibitors)

A

Increase NE and dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MOA of NaSSA (noradrenergic and specific serotonergic antidepressant)

A

Increase 5-HT and NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MOA of TCAs

A

Increase 5-HT and NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MOA of MAOIs

A

Increase 5-HT, NE, and DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MOA of RIMA (reversible inhibitor of monoamine oxidase)

A

Increase 5-HT, NE, and dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the general guidelines for depression tx

A
  • Uncomplicated (physically healthy, outpatient, no CI) –> SSRI (all about equally effective; choice of one over another depends on pt profile & drug profile)
    • Failed trial due to non-response or limiting adverse effect –> ensure adherence, maximize dose (try to wait 8 weeks until increasing); then consider switching to alternative agent (different SSRI, non-SSRI)
  • Partial response –> consider augmentation w/ 2nd antidepressant, lithium, or T3 or T4 or switch to alternative agent
    • Failed trail –> switch to alternative agent
    • Consider ECT?
  • Response/ remission = maintain for at least 4-9 months for continuation & if necessary 12-36 months for maintenance
  • Similar response rates for all antidepressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which antidepressants can be used in combination?

A
  • Venlafaxine + bupropion
  • SSRI + bupropion
  • SSRI + TCA
  • TCA + MAOI **very cautiously
  • *Never use SSRI + MAOI (will get serotonin syndrome)
22
Q

Duration of tx for depression

A
  • 4-9 months after remission
  • Lifelong is < 40 y/o and 2+ episodes or any age and 3+ episodes
  • Poop-out syndrome (initially have response but short lived)
23
Q

Describe ECT (electroconvulsive treatment)

A
  • Candidates = rapid response (suicidal, psychotic), hx of poor response to meds, pregnancy
  • Course = 6-12 tx, unilateral or bilateral, 2-3 times/week
  • Adverse effects = confusion, memory loss months pre & post ECT, CV dysfunction, headache, nausea
24
Q

SSRIs - options, advantage, SE, toxic effects

A
  • Fluoxetine, sertraline, fluvoxamine, paroxetine, citalopram, escitalopram
  • *Remain on a dose for 8 weeks before increasing
  • Advantage –> less SE vs. TCAs b/c lack alpha 1, M1, and H1 effects
  • SE –> agitation, nervousness, restlessness, insomnia/ drowsiness (paroxetine, fluvoxamine), GI effects initially
  • Toxic effects –> tremor, sinus tachycardia, N/V, diarrhea, seizures, serotonin syndrome
25
Q

What determines the choice of an antidepressant over another?

A
  • Personal and family hx
  • Subtype of depression
  • Medication hx/ concurrent meds
  • Potential for drug interactions
  • Adverse effect profile
  • Cost
  • Antidepressant MOA
26
Q

Describe serotonin syndrome

A
  • Diagnosis of exclusion
  • Cognitive/behavioural = agitation, mental status changes (confusion, hypomania)
  • Autonomic dysfunction = diaphoresis, diarrhea, fever, shivering
  • Neuromuscular abnormalities = incoordination tremor, myoclonus, hyperreflexia
27
Q

Causes of serotonin syndrome

A
  • Drugs that inhibit breakdown of 5-HT (MAO inhibitors)
  • Drugs that block reuptake of 5-HT (SSRIs, venlafaxine, clomipramine, dextromethorphan, trazodone)
  • Drugs that are 5-HT precursors or agonists (lithium, buspirone)
  • Drugs that enhance 5-HT release (MDMA)
28
Q

Tx for serotonin syndrome

A
  • Supportive care
  • BZD for neuromuscular sx
  • Tylenol for fever
  • Cyproheptadine 4 mg q4h for severe sx
29
Q

SSRI withdrawal sx

A
  • Somatic:
    • Disequilibrium – dizziness, vertigo, ataxia
    • GI – N/V
    • Influenza-like – fatigue, lethargy, myalgia
  • Psychological – anxiety, agitation, irritability, crying spells
  • *FINISH – flu-like sx, insomnia, nausea, imbalance, sensory disturbance, hyperarousal
  • Occur w/in 1-3 days (up to 1 week)
  • Last up to 7-14 days (may be several weeks)
  • Tx:
    • Prevent w/ gradual tapering
    • If begins to appear, increase dose & taper more slowly
    • If severe, switch to fluoxetine
30
Q

Briefly describe the grapefruit interaction

A
  • Single glass can decrease intestinal 3A4 content more than 50%
  • Duration of action several hours or longer, so separating juice from dose may not prevent interaction
  • Toxicity can occur when pt given higher than usual doses of susceptible med & drinks grapefruit juice for the first time
31
Q

Venlafaxine (SNRI) – MOA and SE

A
  • Increases NE & 5-HT
  • Regarding overdose, not as safe as SSRI but safer than TCAs; once you get up to high doses then similar to TCAs
  • SE = BP increases (dose dependent response, usually reversible on d/c, risk greater w/ increased age), dose related GI effects, dizziness, sexual dysfunction, dry mouth, constipation
32
Q

Bupropion (NDRI) - MOA, SE, advantages

A
  • Good option for px previously on venlafaxine but can’t tolerate GI side effects or BP was increasing too much
  • Increased NE & DA
  • SE = tremor, insomnia, agitation, restlessness, anxiety; seizures at high doses; dry mouth, headache, N/V, rash
  • Advantages = little sexual dysfunction & little weight gain (b/c doesn’t affect serotonin)
  • Other agents can cause disruptions to REM sleep, but bupropion doesn’t (quality of sleep can be better)
33
Q

Mirtazapine (NaSSA) - MOA, advantages

A
  • Affects serotonin as antagonist & affects alpha receptors (would cause orthostatic hypotension, so not great for elderly px) & has some histamine properties (not as bad as TCAs but can be fairly sedating)
  • Advantages –> little sexual dysfunction, less serotonergic effects
34
Q

TCAs - MOA, SE

A
  • Gold standard of therapy; if others don’t work then go to this one (don’t pick this first b/c very non-selective)
  • Increases NE & serotonin; affects histamine, alpha & muscarinic receptors (gives anti-cholinergic side effects)
    • Antihistaminic effects = sedation, weight gain
  • In usual doses, cardiac effects include – hypertension, tachycardia, slowed cardiac conduction, antiarrhythmic properties, orthostatic hypotension
35
Q

“High risk” px for TCA use

A
  • Elderly
  • CV disease
  • Drug interactions
  • Overdose cases
36
Q

Toxic effects of TCAs in overdose

A
  • CV (sinus tachycardia, ventricular arrhythmias, hypotension)
  • CNS (coma, delirium, seizures), other (hyperthermia, urinary retention)
37
Q

TCA withdrawal sx and tx

A
  • Cholinergic and adrenergic rebound
  • Sx = dizziness, nausea, diarrhea, insomnia, hot or cold flashes
  • Taper over 2-4 weeks, tx = restart at low dose or anticholinergic agent
38
Q

MAOIs - MOA, indication, SE

A
  • Irreversible inhibitors of MAO A & B
  • Indicated for atypical or resistant depression
  • Don’t combine w/ other antidepressants (can add to TCA w/ caution)
  • SE = orthostatic hypotension, dry mouth, constipation, sexual side effects (impotence, decreased libido), insomnia
  • Dosed in AM & mid-day to avoid overstimulation
39
Q

General recommendations for washout w/ MAOIs

A
  • Antidepressant –> MAOI = washout 5 t1/2 of antidepressant

- MAOI –> antidepressant = washout 10-14 days

40
Q

RIMA – MOA, example, SE

A
  • Reversible inhibitor of MAO-A
  • Moclobemide
  • SE = HTN, tachycardia, orthostatic hypotension, insomnia
41
Q

General taper/ washout recommendations for all antidepressants

A
  • Can taper when switching from SSRI, novel, or TCA to SSRI, novel or TCA
  • Must washout when switching any antidepressant to a RIMA or MAOI or switching from RIMA or MAOI to another antidepressant
42
Q

Antidepressant recommendations for seizure disorders

A
  • Avoid bupropion and TCAs

- SSRIs, venlafaxine, mirtazapine (?) have less effect on seizure threshold

43
Q

Antidepressant recommendations for sexual dysfunction

A
  • Avoid SSRIs, venlafaxine, TCAs, MAOIs

- Bupropion, mirtazapine, trazodone have little to no effect

44
Q

Antidepressant recommendations for weight gain

A
  • Avoid TCAs, MAOIs, and mirtazapine

- Bupropion, venlafaxine have little to no effect

45
Q

Antidepressant recommendations for elderly

A
  • Use lower initial dosages
  • Evaluate for orthostatic hypotension & cognition
  • Can get excessive sedation from histamine blockade, TCAs, trazodone, & mirtazapine
  • Can get urinary retention (anticholinergic) from TCAs & mirtazapine
46
Q

Antidepressant recommendations for cardiac px

A
  • Venlafaxine increases BP w/ increasing dose
  • Orthostatic hypotension – caution in angina & CHF
  • Increased HR w/ anticholinergic effect – watch in unstable angina
  • Use TCAs w/ caution in hx of arrhythmia + IHD
47
Q

Antidepressant recommendations for pregnancy

A
  • Weigh risks vs. benefits to mother & fetus
  • Most evidence for safety of fluoxetine, then TCAs
  • Can do ECT
  • After delivery – watch for direct drug effects & transient withdrawal sx in infants
48
Q

Antidepressant recommendations for breastfeeding

A
  • Safety evidence for paroxetine, sertraline, fluoxetine, clomipramine, and nortriptyline
  • Monitor infant daily for changes in sleep, feeding patterns, and behaviour; monitor for drowsiness and difficulty feeding
49
Q

Antidepressant recommendations for children and adolescents

A
  • Moderate to severe MD (major depression)
    • First line = fluoxetine and citalopram
    • Second line = other SSRIs (paroxetine > adverse effects)
    • Third line = venlafaxine
    • Best outcomes w/ combine CBT w/ antidepressant
  • TCAs not recommended b/c risks&raquo_space; benefit (lethal in overdose, rare cases of sudden death)
  • Increased risk for suicidal behaviour; *monitor suicidal thoughts
  • Continue tx if effective for 6 months; gradually d/c over 6 weeks
50
Q

Response vs. remission vs. recovery

A
  • Response = 50% reduction in sx
  • Remission = sx go away
  • Recovery = remission lasting 6-12 months

Year 3 - Clinical (Winter) (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions