Ch14: Mental Health Flashcards
SIGECAPS mnemonic for major depressive disorder symptoms
S - sleep I - interest G - guilt E - energy C - concentration A - appetite P - psychomotor S - suicidality
MDD diagnostic criteria
5 or more symptoms present in the same 2 week period, one of which must be (1) depressed mood and/or (2) loss of interest or pleasure in usual activities
- insomnia or hypersomnia, staying asleep is problematic
- feelings of worthlessness
- fatigue or loss of energy
- diminished ability to think clearly or make decisions
- loss of food enjoyment, increase or decrease in appetite
- psychomotor retardation or agitation
- recurrent thoughts of death, passive without a plan, or active suicidality
diagnostic criteria of GAD
3 or more of the following symptoms reported as occurring on most days for 6 or more months
- worry that is disproportionate to daily concerns, continued to worry even when the concerning event resolved
- anxiety with mental and physical hypervigilance
- muscular tension, GI upset
- reports of mind racing, difficulty with concentration
- hyperarousal - irritability is common
- energy loss, fatigue, chronically feeling tired despite adequate opportunity to rest
- restlessness, constantly feeling physically “keyed up”
- classically difficult to initiate sleep
WATCHERS mnemonic for GAD symptoms
W - worry A - anxiety T - tension in body C - concentration difficulty H - hyperarousal E - energy loss R - restlessness S - sleep disturbance
remission of symptoms in GAD/MDD typically takes how long with medication? how long should someone be on these?
- time to remission typically takes 4-8 weeks (~6 weeks to feel effect of that dose)
- if they have a second episode, consider longer-term maintenance therapy
- when tapering off medication, taper over >6 weeks to avoid discontinuation syndrome and monitor carefully for mood disorder relapse
in someone with a mood disorder with vegetative symptoms, avoid prescribing an SSRI that is….
sedating
in someone with a mood disorder with energy/anxiety/restlessness, avoid prescribing an SSRI that is…
activating
most activating of the SSRIs
fluoxetine (Prozac)
most sedating of the SSRIs
paroxetine (Paxil)
middle of the road SSRIs in terms of sedating vs. activating (3)
- sertraline (Zoloft)
- citalopram (Celexa)
- escitalopram (Lexapro)
medication class with the best effect (first line) on lifting and smoothing mood
SSRIs
SNRIs have similar effects to SSRIs but additionally help with….
increasing focus
medication class: venlafaxine (Effexor)
SNRI
medication class: duloxetine (Cymbalta)
SNRI
medication class: desvenlafaxine (Pristiq)
SNRI
the SNRIs as a class tend to be more [sedating vs. activating], but not terribly
activating
medication class: fluoxetine (Prozac)
SSRI
medication class: sertraline (Zoloft)
SSRI
medication class: citalopram (Celexa)
SSRI
medication class: escitalopram (Lexapro)
SSRI
medication class: bupropion (Wellbutrin)
SDRI (selective dopamine reuptake inhibitor)
the SDRI bupropion as a class tend to be more [sedating vs. activating], but not terribly
activating
helpful add-on agent when someone with MDD has an incomplete response with an SSRI
bupropion (Wellbutrin) - SDRI
appropriate use and indication for buspirone (Buspar)
anxiolytic, helpful in alleviating hypervigilance associated with anxiety, not as useful for worry
buspirone is not rapid-acting like the benzos, this needs to be used regularly for many weeks before feeling an effect (common misconception that can be taken PRN with providers)
what is the single most common adverse effect with SSRIs, SNRIs, and SDRI?
sexual dysfunction = 20-40%
anorgasmia, erectile dysfunction, altered libido
FDA BBW on SSRIs
increased the risk of suicidal thinking and behavior in children, adolescents, and young adults <24yo in short-term studies, this has not been noted in adults >24yo
in adults 65yo or older, the use of antidepressants reduces suicidality risk
SSRI with a remarkably long half-life
fluoxetine (Prozac) - half life of 84 hrs, metabolite 7-15 days
which SSRI is not a CYP450 isoenzyme inhibitor at all :)
escitalopram (Lexapro)
which SSRIs (2) are the least inhibiting of CYP450 isoenzymes
- escitalopram (Lexapro)
- citalopram (Celexa)
which SSRI is the most inhibiting of CYP450 isoenzymes?
fluoxetine (Prozac)
which SSRI has a dose limitation due to potential QT prolongation?
citalopram (Celexa)
the SSRI with the longest half life, _____, is thus a poor choice for which patient population?
fluoxetine (Prozac)
poor choice in elderly adults (reduced clearance of medications)