Antidepressant Pharmacotherapy

Question 1

median age for depression

Answer 1

30 years

Question 2

leading cause of disability ages 15-44 and worldwide

Answer 2

mental illness

Question 3

 10 million or 4.2% of adults

Answer 3

 10 million or 4.2% of adults

Question 4

Suicide stats

Answer 4

 10th leading cause of death in the U.S.
 the 3rd leading cause of death for people aged 10–24
 2nd leading cause of death for people aged 15–24

Question 5

for about 50% of indviduals mental illness manifests by

Answer 5

14 years

Question 6

women have

Answer 6

twice the rate of depression than men do

Question 7

what ethic group has lowest incidence of depression

Answer 7

asain men

Question 8

Conditions associated with MH Illness

Answer 8

Hypothyroidism
 Dementia, stroke
 Rheumatoid arthritis
 CHF, MI
 Vitamin B-12 deficiency
 Cancer
 Parkinson’s Disease
 DM

Question 9

Drugs associated with MH illness

Answer 9

 Alcohol/Substance use
 Antihypertensives
 Antiparkinsonian agents
 Hormonal preparations
 Anticancer agents
 Psychotropic agents

Question 10

Risk Factors for Depression first four

Answer 10

 Prior episode of depression
 FMH of mood disorders
 Prior suicide attempt
 Current substance abuse

Question 11

risk factors for depression last three

Answer 11

 Medical neurological comorbidity
 Lack of social support
 Stressful life events

Question 12

DSM-5 depression dx critera

Answer 12

One or both for 2 weeks:
 Depressed, irritable mood
 Loss of interest or pleasure
AND 3-4 of the following symptoms:
 Change in weight/appetite
 Change in sleep pattern
 Agitated/restless
 Fatigue/loss of energy
 Feelings of worthlessness or guilt
 Difficulty with concentration of memory
 Frequent thoughts of death or suicide
 Classification of Depression

Question 13

History and assessment first four

Answer 13

 Identify presenting symptoms
 Establish the course of the illness
 Obtain: PMH and medication history, FMH, psychosocial
history
 Assess physical status

Question 14

History and assessment last three

Answer 14

 Establish psychological baseline
 Assess for suicidality/thoughts of harm
 Obtain laboratory baseline

Question 15

Mood disorders =

Answer 15

neurotransmitter deficiency

Question 16

neuortransmitters

Answer 16

serotonin (5ht)
dopamine
norepinepherine

Question 17

Examples of mood disorders

Answer 17

Major depression
 Dysthymia
 Bipolar I Disorder
episodes sustained mania; often depression
 Bipolar II Disorder
1 or more major depressive episodes; at least 1 episode of hypomania
 Minor Depression

Question 18

baseball approach to neurotransmitter selectivity

Answer 18

1st base serotonin 5ht
2nd base 5h2a
3rd base 5ht3
home plate NE
Pitcher DA

Question 19

5HT reuptake inhibitor

Answer 19

increases synaptic serotonin

Question 20

5HT2A

Answer 20

Decreases sleep, Decreases libido

Question 21

5HT3

Answer 21

Nausea/GI upset

Question 22

NE

Answer 22

Decreases Lethargy

Question 23

DA

Answer 23

Increases attention

Decreases Addiction/Craving

Question 24

NE only effects

Answer 24

Vigilance
Concentration
Motivation
Interest

Question 25

Serotonin Only effects

Answer 25

Impulsivity
Sex
Appetite
Agression

Question 26

NE and Serotonin effects

Answer 26

Mood
Emotion
Anxiety
Pain
Irritability
Cognitive Function

Question 27

Serotonin Residual Symptoms

Answer 27

• Anxiety
• Inhibited communication
• Dysfunctional attitude
• High neuroticism
• ∗Social maladjustment
• ∗Insomnia
• Psychic and somatic anxiety
• Guilt and lowered self-esteem
• Hopelessness
• Impaired work and interests
• Psychosocial disability
• Sexual symptoms
• Anhedonia
• Lack of motivation

Question 28

NE residual related symptoms

Answer 28

•∗Excessive reactivity to social
stress
•Fatigue
•Interpersonal friction
•Irritability

Question 29

Dompamine Related residual symptoms

Answer 29

•Cognitive Impairment •Anxiety Fatigue

Question 30

Look before you LEAP

Answer 30

 Libido
 Energy
 Attention/Addiction
 Points to Ponder
 Things you should know about medications