Antidepressants Flashcards
Name the antidepressants and their starting dose that are preferred in postpartum depression
1) PO sertraline 50 mg ON
2) PO paroxetine SR 25 mg OD
Antidepressants commonly associated with QTc prolongation
Escitalopram
Antidepressant associated with the most weight gain as well as drowsiness
Mirtazapine
Can fluoxetine be used in pregnancy?
Not recommended due to long half life which leads to accumulation in fetal circulation
Which class or classess of antidepressants are most commonly associated with orthostatic hypotension?
- TCAs
- MAOI
Supplement that can be recommended in patients with MDD?
Omega-3 fatty acid
Preferred therapy for young people ≤18yo with mild depression?
Psychotherapy (e.g. cognitive-behavioural therapy, etc.)
Preferred therapy for young people ≤18yo with moderate-severe depression? If pharmacotherapy is suggested, state the name, dose and titration
First line: psychotherapy for at least 3 months (NICE, 2019)
After that: can trial combined psychotherapy and pharmacotherpay:
Pharmacotherapy option: fluoxetine 10 mg OD, titrate up to 20 mg after 1 week if clinically required
Is electroconvulsive therapy a long or short term? If it is short-term, state what else needs to be done after ECT.
Short-term therapy
- Maintained on anti-depressants after ECT
When antidepressants are started, when will the emergence of suicide behaviour usually surface?
1-2 months after initiation of antidepressants
If patient has agitation episodes upon initiation of antidepressants, what are the class of drugs that can be added to manage these symptoms?
Benzodiazepines (while the antidepressants take time to work)
Treatment duration for the following patients:
a) First episode of depression without psychotic symptoms
b) Second episode of depression
c) More than 2 episodes of depression
a) Full dose of antidepressants for 6 - 9 mo
b) 1 - 2 years
c) > 2yrs or lifelong
When is the earliest time that a patient can expect improvement after being newly started on antidepressants?
4-6 weeks for partial improvement
How to switch from SSRI to SNRI for:
a) Low dose SSRI
b) High dose SSRI
a) Low dose: stop SSRI and start SNRi immediately
b) High dose SSRI: Cross-taper - decrease SSRI dose and initiate or titrate up SNRI dose at the same time
Best antidepressant for patient who is smoking and is obese?
Bupropion (indicated for depression and smoking, and also has anotexic effect to help weight loss)
HAM-D score for different severity of depression?
- Mild: 10-13
- Moderate: 14-17
- Severe: >17
Do we start antidepressants in a patient with mild MDD?
No. Only start if non-pco was not effective for ≥6 mo
What is an “adequate trial” of antidepressant
Newly started antidepressant with monitoring for at least 4-8 weeks, before deciding if it is effective or not
Additional indications for duloxetine
- Diabetic peripheral neuropathy
- Fibromyalgia
- Chronic musculoskeletal pain (e.g. OA knees)
Non-pharmacological management of MDD
- Sleep hygiene
- CBT
When switching SSRIs, when is washout period required?
When switching MAOIs
- Switch from MAOIs to something else: 24h (for moclobemide)
- Switch from something to MAOI: ≥1 week (5 weeks for fluoxetine)
Is fluoxetine more likely to cause drowsiness or insomnia?
Insomnia
Herb that has high potential to interact with antidepressant hence not recommended to be used?
St. John’s Wort
Antidepressant(s) that has fewer CYP interactions
Mirtazapine, escitalopram, venlafaxine, desvenlafaxine, vortioxetine
Goal of therapy in depression
Remission of symptoms
Initial dose of mirtazapine in elderly?
7.5 mg ON (due to decreased clearance)
