Antidepressant Drugs Flashcards
Antidepressant drugs are effective for treating moderate to severe depression associated with __________ and ____________ changes such as loss of appetite and sleep disturbance
psychomotor
physiological
Antidepressant drugs are effective for treating moderate to severe depression associated with psychomotor and physiological changes such as _____________ and ____________
loss of appetite
sleep disturbance
What is typically the first benefit of antidepressant therapy?
Improvement in sleep
Ideally, patients with moderate to severe depression should be treated with ____________ in addition to drug therapy.
psychological therapy
What is dysthymia?
lower grade chronic depression; typically of at least 2 years duration
Dysthymia is a type of ________ (higher/lower) grade chronic depression that is typically of at least __________ duration
Lower
2 years
Antidepressant drugs should not be used routinely in _________ depression
mild
*psychological therapy should be considered initially
When are antidepressants used in the treatment of mild depression?
psychological therapy should be considered initially; however, a trial of antidepressant therapy may be considered in cases refractory to psychological treatments or in those associated with psychosocial or medical problem
In addition to patients with MILD depression in whom depression is refractory to psychological treatment, which other patients may be considered for antidepressant therapy?
Patients with a history of moderate or severe depression
What are the major classes of antidepressants? (4)
- TCAs
- SSRIs
- MAOIs
- SNRIs
Since there may be an interval of ________ before the antidepressant action takes place, electroconvulsive treatment may be required in severe depression when delay is hazardous or intolerable
2 weeks
Since there may be an interval of 2 weeks before the antidepressant action takes place, ____________ may be required in severe depression when delay is hazardous or intolerable
electroconvulsive treatment
During the first few weeks of treatment with antidepressants, there is an increased potential for _________, __________, and __________.
agitation
anxiety
suicidal ideation
__________ are better tolerated and are safer in overdose than other classes of antidepressants and should be considered first-line for treating depression.
SSRIs
In patients with unstable angina or who have had a recent myocardial infarction, ____________ has been shown to be safe in the treatment of depression
sertraline
______________ have similar efficacy to SSRIs but are more likely to be discontinued because of side-effects; toxicity in overdosage is also a problem
Tricyclic antidepressants
SSRIs are less __________ and have fewer ________ and ________ effects than tricyclic antidepressants.
sedating
antimuscarinic
cardiotoxic
__________ (class of antidepressants) have dangerous interactions with some foods and drugs, and should be reserved for use by specialists
MAOIs
___________ or __________ drugs should be used with caution in depression due to the risk of masking the true diagnosis, but they are useful adjuncts in agitated patients
Anxiolytics
antipsychotic
Augmenting antidepressants with __________ under specialist supervision may also be necessary in patients who have depression with psychotic symptoms
antipsychotics
Augmenting antidepressants with antipsychotics under specialist supervision may also be necessary in patients who have depression with ____________ symptoms
psychotic
Although anxiety is often present in depressive illness (and may be the presenting symptom), the use of an antipsychotic or an anxiolytic may _____________.
mask the true diagnosis
What is St John’s wort?
A popular herbal remedy for treating mild depression
Also a CYP450 inducer
St John’s wort can _________ (induce/inhibit) drug metabolising enzymes and a number of important interactions with conventional drugs, including conventional antidepressants, have been identified.
Induce
If a patient stops taking St John’s wort, the concentration of interacting drugs may _______ (increase/decrease), leading to toxicity.
Increase
What are the most commonly prescribed SSRIs? (5)
- Citalopram
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
What are the most commonly prescribed SNRIs? (2)
- Venlafaxine
2. Duloxetine
What are the most commonly prescribed TCAs? (5)
- Amitriptyline
- Clomipramine
- Nortriptyline
- Imipramine
- Lofepramine
What are the most commonly prescribed MAOIs? (4)
- Tranylcypromine
- Phenelzine
- Isocarboxazid
- Moclobemide
Patients should be reviewed every _________ at the start of antidepressant treatment
1–2 weeks
Treatment should be continued for at least __________ (________ in the elderly) before considering whether to switch antidepressant due to lack of efficacy
4 weeks
6 weeks
In patients being treated with antidepressants, how should partial response be managed?
In cases of partial response, continue for a further 2–4 weeks (elderly patients may take longer to respond)
Following remission, antidepressant treatment should be continued at the same dose for at least _________ (about __________ in the elderly), or for at least __________ in patients receiving treatment for generalised anxiety disorder (as the likelihood of relapse is high).
6 months
12 months
12 months
Patients with a history of recurrent depression should receive maintenance treatment for at least __________.
2 years
Which electrolyte disturbance has been associated with all types of antidepressants?
Hyponatremia, usually in elderly
Hyponatremia has been reported more frequently with ________ than with other antidepressants
SSRIs
_____________ should be considered in all patients who develop drowsiness, confusion, or convulsions while taking an antidepressant
Hyponatraemia
Hyponatraemia should be considered in all patients who develop ___________, ___________, or __________ while taking an antidepressant
drowsiness
confusion
convulsions
The use of antidepressants has been linked with suicidal thoughts and behaviour; which patient demographics are particularly at risk? (3)
- Children
- Young adults
- Patients with a history of suicidal behavior
Where necessary patients being treated with antidepressants should be monitored for suicidal behaviour, self-harm, or hostility, particularly at the __________ of treatment or if ___________
beginning
the dose is changed
What is serotonin syndrome?
a relatively uncommon adverse drug reaction caused by excessive central and peripheral serotonergic activity
What are the symptoms of serotonin syndrome? (3)
Range from mild to life-threatening
- Neuromuscular hyperactivity: tremor, hyperreflexia, clonus, myoclonus, rigidity
- Autonomic dysfunction: tachycardia, BP changes, hyperthermia, diaphoresis, shivering, diarrhea
- Altered mental state: agitation, confusion, mania
What factors may precipitate serotonin syndrome in a patient? (5)
Can occur within hours or days following:
- Initiation of treatment
- Dose escalation
- Overdose of serotonergic drugs
- Addition of a new serotonergic drug
- Replacement of one serotonergic drug by another without allowing a long enough washout period in between (particularly when the forest drug is in irreversible MAOI or a drug with a long half-life)
Severe toxicity, which is a medical emergency, usually occurs with a combination of serotonergic drugs, one of which is generally a(n) _________.
MAOI
What is the treatment of serotonin syndrome?
- Withdrawal of serotonergic medication
2. Supportive care
What are the main classes of serotonergic drugs? (10)
- SSRIs
- SNRIs
- Bupropion
- TCAs
- MAOIs
- Anti-migraine medications eg carbamazepine, valproate, triptans
- Pain medications eg opioids including over-the-counter cough syrups
- Lithium
- Antiemetics including 5-HT antagonists and D2 antagonists
- St John’s wort
What is the mechanism of action of bupropion?
Norepinephrine and dopamine reuptake inhibitor (SNDRI)
Failure to respond to initial treatment with an SSRI may require _____________, or ____________.
an increase in the dose
switching to a different SSRI or mirtazapine
In which drug class is the antidepressant mirtazapine?
Alpha-2 antagonist
____________ and __________ should be considered for more severe forms of depression
tricyclic antidepressants
venlafaxine
______________ may be initiated in severe refractory depression
Electroconvulsive therapy
Failure to respond to a second antidepressant may require the addition of ____________, or use of an augmenting agent like _________, __________, ____________, __________, or __________ under specialist supervision
another antidepressant of a different class
Lithium
Aripiprazole (unlicensed)
Olanzapine (unlicensed)
Quetiapine
Risperidone (unlicensed)
Management of acute anxiety generally involves the use of a ____________ or _____________.
benzodiazepine
buspirone hydrochloride
For chronic anxiety (of longer than 4 weeks’ duration) it may be appropriate to use a(n) _____________
antidepressant; particularly SSRI or SNRI
For patients with newly diagnosed anxiety, combined therapy with a ____________ may be required until the antidepressant takes effect
benzodiazepine
Patients with generalised anxiety disorder, a form of chronic anxiety, should be offered _____________ before initiating an antidepressant.
psychological treatment
For patients with chronic anxiety, a(n) ___________ such as ____________, ___________, or __________ [unlicensed], can be used if drug treatment is needed
SSRI
escitalopram
paroxetine
sertraline
In addition to SSRIs escitalopram, paroxetine, and sertraline, _____________ and ____________ (SNRIs) are also recommended for the treatment of generalised anxiety disorder
Duloxetine
venlafaxine
In patients with chronic anxiety, if SSRIs or SNRIs are not tolerated (or if treatment has failed to control symptoms), ____________ can be considered
pregabalin
Panic disorder is treated with _________
SSRIs
_______________ or __________ can be used second-line in the treatment of panic disorder. ____________, an SNRI, is also licensed for panic disorder.
clomipramine hydrochloride [unlicensed]
imipramine hydrochloride [unlicensed]
Venlafaxine
Obsessive-compulsive disorder, post-traumatic stress disorder, and phobic states such as social anxiety disorder are treated with ______________
SSRIs