antidepressants Flashcards
what are some mood disorders?
depression, dysthymia (low level depression status), bipolar disorder, cyclothymia (mood swings, less than bipolar), postnatal depression
According to Statistics Canada’s 2012 Canadian Community Health Survey (CCHS) on Mental Health, ___ of the Canadian population aged 15 years met the criteria for a mood disorder in the previous 12 months,
including including ___ for major depression and __ for bipolar disorder.
- 4%
4. 7%, 1.5%
At least __ of people following their first episode of major depression will go on to have at least one more episode and after the second and third episodes, the risk of further relapse rises to__ and __ respectively.
50%, 70 to 90%
what type of men (ethnicity) over the age of 65 are at a disproportionate risk for suicide? and which type of woman over 80?
caucasian and asian men over 65 and asian woman over 80
what is often a contributing factor for suicide?
substance abuse
__% of elderly suicide compelteres were seen by their doctor within one month of death?
75%
how soon should someone be hospitalized if they have high levels of these risk factors: Internal emotional pain (e.g., feelings of shame, guilt, humiliation), External stress (e.g., loss of spouse, job, legal troubles), Agitation (e.g., from sleep loss, drug use, or excessive anger), Hopelessness
immediately
et of depression?
unclear
2 theories- monoamine neurotransmitter dysfx and neuroendocrine factors.
others are immune, genetics, and env’t
medical causes of depression?
Reserpine, steroids, alpha-methyldopa, propranolol and hormonal therapy may be associated with major depression.
Active abuse or withdrawal from alcohol, cocaine, sedatives, opiates, cannabis, anxiolytics, hypnotics and amphetamines
med conditions: hypothyroidism, cardiovascular disease
what disease has a bidirectional relationship with depression?
coronary artery disease.
can cause dep or dep is a risk factor for CAD
dep may contribute to sudden cardiac death and dep contributes to poor lifestyle (risk factor)
what are tricyclic antidepressants also used for?
urinary retention
why are monoamine oxidase inhibitors rarely used today?
so many dietary restrictions
key factor with new antidepressants (SSRIs and SNRIs)
they are highly protein bound!
antidepressants must be taken ___ weeks before depressive symptoms improve
2-4 weeks before
what do you need to note with SSRIs and metabolism?
metb is executed in part by CYP2D6 and patients are classified into carrying functioning UM (ultra-metb), EM (extensive) IM (intermediate), and PM (poor metb)
where antidepressants abrosrbed and metb?
absorbed from small bowel and metb in the liver
/MOA of antidepressants
normalize abnormal neurotransmission, may modify interactions among neurotransmission systems, may affect endocrine function, attributed to changes in receptors rather than changes in neurotransmitters lithium is unknown
indications for anti-depressants?
Depressive symptoms persist at least 2 weeks
Impair social relationships or work performance
Occur independently of life events
Treatment of anxiety disorders
Enuresis management
Neuropathic pain management
contraindications for antidepressants?
suicide, mixed mania and depression, acute schizophrenia, narrow angle glaucoma, severe renal, hepatic or cardiovascular disease
do SSRIs have more or less SE than TCA?
less with similar positive results
how long is an SSRI half life?
LONG. 24-72 hours. highly protein bound as well
what od you have to be aware of for SSRis in regards to GI ?
because sertaonin release from platelets is essential for haemostats and psychotic drugs interfere with sertaonin reuptake, these gents are associated with inc risk of GI bleeding
what drugs inc the risk for GI bleeding with SSRIs?
NSAIDS, ASA or warfarin
why should you be cautious with teens and SSRIs?
inc risk of suicide
where is lithium metb?
not metb by the body, entirely secreted by the kidneys.
what organ would you need to ensure functions very well before you give lithium?
kidneys bc not metb body the body and entirely secreted by the kidneys
also cardiac and thyroid
factors to consider in drug selection?
Client’s age Client’s medical conditions Previous history of drug response Specific medication’s adverse effects Cost of medication
T or F antidepressants should be individualized to clients age?
F to clinical response
after first episode od depression how long do you treat after symptoms subside?
9 months
after second episode how long do you treat depression?
5 yeears
after 3rd episode of depression how long do you proceed with treatment?
long term
how long do you treat with lithium?
long term bc high recurrence rate if med is d/c
what antidepressant are potentially lethal when overdosed and are highly toxic?
TCAs
what is serotonin syndrome?
overstimulation of serotonin receptors
triad of mental, autonomic and neurological symp
can be fatal
s
what are the symp of serotonin syndrome?
Symptoms include confusion, agitation, tachycardia, dyspnea, high or low blood pressure, myoclonus, tremors, chills, rigidity, and hyper-reflexia.
when does serotonin syndrome typically present?
within 24 hours following admin of therapeutic doses, intentional overdose or inadvertent drug interactions
what is antidepressant discontinuation syndrome?
Reported with sudden termination of most antidepressant medications
how long do you taper and gradually d/c antidepressants?
6-8 weeks
what are some SSRis symptoms with antidepressant discontinuation syndrome?
Dizziness, dysphoria, GI upset Sleep problems, lethargy, headache Anxiety/hyperarousal More serious symptoms Aggression, hypomania, mood disturbances, suicidal tendencies
what are some TCA symptoms of antidepressant discontinuation syndrome?
Hypersalivation Diarrhea Urinary urgency Abdominal cramping Sweating
which medication can be fatal with an overdose as little as 1g?
Venlafaxine (Effexor):
what medication causes incr. sleep, often given with stimulant antidepressants like bupropion
Trazodone (Desyrel):
what medication are you worried about risk of seizures with doses over 450 mg/day
Bupropion (Wellbutrin, Zyban)
lithium dosage is based on?
Serum lithium levels
Control of symptoms
Occurrence of adverse effects
therpateuic range for lithium? maintenance range?
- 8-1.4 mEq/L therapeutic range during acute mania
0. 4 – 1.0 mEq/L maintenance range
toxicity blood level for lithium?
(toxicity can start at 1.5 mEq/L)
which pop are you worried about for lithium?
older adults-> inc risk of tox
what nutritional counselling do you provide with lithium?
: importance of adequate fluid and sodium intake (When decreased sodium intake, kidneys retain lithium -> toxicity)
half life of lithium? when do the effects begin?
short half life so needs to be taken 2-3x/day
works within 7-14 days
what bipolar med has many serious side effects? what are they?
Carbamazepine (Tegretol)
SE’s – sedation, ataxia, aplastic anemia, agranulocytosis
Monitor for blood dyscrasias (fever, lethargy, etc)
Need to wear sunscreen – risk of dermatitis, Stevens-Johnson Syndrome (life-threatening hypersensitivity skin condition, starts with flu-like symptoms)
risks for valproate sodium?
risk for birth defects and hepatoxicity
risks for lomotrigine?
Anticonvulsant, best for Bipolar depression
Adverse Effects: blurred vision, watch for Stevens-Johnson Syndrome
what is carbamazepine most effective for?
mixed states, rapid cycling
