Antidepressant Deck 3

Question 1

Treatment principles

Answer 1

Goals
Strategic and tactical decision making
patient counseling

Question 2

Strategic and Tactical Decision-Making

Answer 2

Patient factors
Disease Factors
Drug Factors
Optimum Plan

“The whether and what”

Question 3

You don’t want to treat to ____ you want to treat to __

Answer 3

response

remission

Question 4

Initiation

Answer 4

Targeted Therapy
Dosing
Frequent Monitoring

Question 5

Antidepressent most side effects are worse within

Answer 5

the first couple of weeks

Question 6

Targeted therpay

Answer 6

y Patient factors
y Drug factors
y Disease Factors/Co-morbidities

Question 7

Frequent Monitoring

Answer 7

y Weekly-biweekly
y Suicide risk
y Adverse effects
y Expected outcome/Effects

Question 8

Titration: Med change every

Answer 8

3-14* days

Question 9

you want to get to a

Answer 9

therapeutic dose

Question 10

If no response and you are at a maximum dose at 8 to 12 weeks

Answer 10

y Change to different class or change to different med w/in same
class if no response after 8-12 weeks of maximum dose

Question 11

Oher options if you are at a maxium dose

Answer 11

add a second agent

refer to psych consultation

Question 12

Follow up:

Answer 12

every 1-2 weeks for 6-8 weeks in initiation;

every 2 months for severe

Question 13

Use _____ to monitor symptoms

Answer 13

clinical tools

Question 14

Usual course of treatment

Answer 14

Major depression: 6-9 months*

Long term treatment may be needed

Question 15

Common causes of treatment failure

Answer 15

y Inadequate dose or duration of treatment
y Prominent side effects
y Non-compliance
y Incorrect diagnosis

Question 16

Plasma levels: when to use

Answer 16

y Failure to respond/use of higher than usual doses
y Impaired physical status
y S/E evaluation and/or overdose

Question 17

Partial response: consider

Answer 17

augmentation

Question 18

Factors to consider with augmentation

Answer 18

Efficacy, tolerability, side effect burden, drug interactions, dosing
convenience, adherence, cost

Question 19

You want to add an agent from

Answer 19

Add agent from a different class
y Wellbutrin, BuSpar (most commonly added)

Question 20

Examples of other agents

Answer 20

y Anxiolytics
y Antipsychotics and mood stabilizers
y Psychostimulants
y DHEA
y Triiodothyronine (T3)
y Ketamine?

Question 21

What is not recommended due to interaction with SSRI

Answer 21

St. john’s wart - significant. Increases effects of SSRI

Question 22

Withdraw medication

Answer 22

slowly. 2 to 4 week taper

Question 23

Taper method

Answer 23

decreasing dose, then every other day, or a half a dose at a time. Depends on the indvidual

Question 24

RCT: no difference in

Answer 24

no difference in symptoms between 3 day and 14 day

taper - anecdotally not Mary’s experience

Question 25

Monitor what during withdrawl period

Answer 25

mood

Question 26

review what during taper

Answer 26

relapse criteia

Question 27

consider what during taper

Answer 27

seasonal and situational data

Question 28

SSRI/SNRI disconintuation syndrome in adults acronym

Answer 28

FINISH

Question 29

F

Answer 29

Flu like symptoms: fatigue, H/A, myalgias, diarrhea

Question 30

I

Answer 30

Insomnia: vivid or disturbing dreams

Question 31

N

Answer 31

Nausea

Question 32

I

Answer 32

Imbalance: gait instability dizziness vertigo mbalance: gait instability, dizziness, vertigo

Question 33

S

Answer 33

Sensory imbalance: paresthesia, “electric shock” sensation,

visual disturbances

Question 34

H

Answer 34

Hyperarousal: anxiety, agitation

Question 35

Onset and resolution of FINISH

Answer 35

Onset: 24-72h + resolution:1-14 days

Question 36

Incidence of Finish

Answer 36

Incidence: 20-40% (treated at least 6wks)

Question 37

Serotonin Syndrome S/S

Answer 37

y Signs and Symptoms
y CNS and neuromuscular
y Autonomic instability
y GI: nausea, diarrhea
y Onset: often rapid (minutes); may be life threatening

Question 38

Serotonin Syndrome treatment

Answer 38

y Stop medication
y Benzodiazepines for agitation, hyperreflexia
y Treat individual symptoms (depends on severity)