Chapter 14 Book Depression Flashcards
SE: Agitation, insomnia, headache, NV, Sexual Dysfunction, hyponatremia
Class
SSRI
This SNRI inhibits reuptake of norepinephrine more than 5 HT.
SE: OH, constipation, sweating, increased HR, palpitations, difficulty urinating, decreased appetite, Sexual Dysfunction
Levomilnacipran
This SNRI is approved for GAD.
SE: N, xerostomia, insomnia, somnolencia, constipation, reduce appetite, fatigue, sweating, blurred vision
Duloxetine
Venlafaxine SNRI is popular choice after SSRI.
WARNING
Monitor BP esp at high levels
Nefazodone, Trazodone, Vilazodone, Vortioxetine
This class
Serotonin Antagonist and Reuptake Inhibitor
Bupropion NDRI smoking stopper at low dose (poor man’s coccaine)
Has this Contradiction
Seizures
Use caution in older adults with Cardiac Problems, Elevated intraocular pressure, urinary retention, Hyperthyroidism, seizures, liver & Kidney dysfunction. Lethal in OD
Tricyclic antidepressants
Amitriptyline
Amoxapine
Doxepin
Imipramine
Nortriptyline
Disruptive mood dysregulation is….
Why was the diagnosis invented….
Constant & severe irritability and anger Ages 6 - 18
To prevent them from being labeled bipolar and taking wrong meds.
They grow outta it and become either depressed or Anxious
Persistent depressive disorder/ Formerly Dysrhthmias
Is this level ____ of depression that last 2 years Most days of the week
In addition have atleast 2 of the following: appetite problems, insomnia/ hypersomia, low energy, poor Self-Esteem, difficulty thinking hopelessness
Low level
Premenstrual Dysphoric Disorder
Can best be relieved by..
Which SSRIs
Regular exercise, carbohydrate rich foods & sleep, acupuncture, light therapy, relaxation.
Fluoxetine, Sertraline, Controlled release Paroxetine
Major depressive disorder is characterized by 5 or more symptoms of depression lasting atleast how long….
2 weeks
Can a person whose son just died last month be considered clinically depressed
Yes
Now the Bereavement exclusion is removed from the DSM
Leading cause of disability worldwide.
Most common psychological illness in USA
Depression
Anxiety
Women are more depressed than men.
Biracial people are the most depressed race
T & T
Two main neurotransmitters involved in mood are..
5 HT & norepinephrine
Serotonin or Norepinephrine
Attention
Behavior
Sleep
Appetite
Sex drive
Impulse control
Irritability
Norepinephrine
Attention
Behavior
Serotonin
Sleep
Appetite
Sex drive
Impulse control
Irritability
Hyperactivity of HPA & increased urine cortisol & elevated corticotrophin-releasing hormones
Are associated with depression?
T
C-reactive protein & interleukin-6 may play a role in depression. What do they both do?
Inflammation
This score on the PHQ-9 is qualification for a referral to mental help
> 9
This is the Hallmark symptom of depression
Sleep pattern disturbance
Words to describe Mood are….
Euthymic (normal)
Euphoric (Overly happy)
Angry
Irritable
Anxious
Apethic
Moods can change quickly and need to be assessed often
T or F
F
Moods last from several hours to days.
Feelings & emotions change frequently
Moods include
Worthless, guilt, helpless, hopeless, anger
T or F
F
These are feelings which can change in minutes. Moods are Euthymic, Euphoric, angry, irritable, anxious, apathetic
Inability to solve problems may lead to this feeling / emotion
Helplessness
Are psychotic feature Hallucinations ever present with depression?
Yes, in severe
The core symptom of depression in children & adolescents is…
Same as adults
Sadness & loss of pleasure
3 phases of treatment for major depression & time frame
Acute 6 - 12 weeks (reduction of depression & restoration of function)
Continuation phase 4 - 9 months ( Prevent relapse )
Maintenance >1 year prevent further episodes. Meds may be Discontinued
Fluoxetine gives energy or makes tired
Mirtazapine gives energy or makes tired
Bupropion makes horny?
Give these for chronic pain
Fluoxetine gives energy
Mirtazapine makes tires
Bupropion makes horny
TCA or Duloxetine
Do SSRI have anticholinergic effects
Dry mouth, blurry vision, urinary retention
No
Patient should Discontinue SSRI for how long before stating an MAIO
2 - 5 wks
How long to be off SSRI before starting MAIO
2 - 5 weeks
Esketamine affects this neurotransmitter
Glutamate
No eating / drinking 2 hrs before esketamine
HTN = SE
When can patient drive themselves home after treatment
Can’t.
Must be monitored for 2 hrs
And no driving until following day
Brexanolone is ….
Neurotransmitter….
Delivery method
Serious SE
Postpartum
GABA
IV over 2.5 days
Hypoxia, dry mouth, flushing, hot flashes
2nd line of treatment for depression
TCAS
TCAs
Major SE
Anticholinergic: Urine retention
Heart: Tachycardia
Sedative: Use at night
OD = Death
Recent MI
Seizures
Narrow angle glaucoma
Preggers
Contradictions for…
TCAs
SE of MAOI is HTN or hypotension
Both
Hypotension common
HTN with Tyramine
BP should be monitored with these meds
MAIO
HTN Crisis with MAIOs
Gastric lavage / charcoal maybe done if recent ingested
True
Contradictions
Cerebrovascular disease
HTN CHF
Liver disease
Tyramine, L-tryptophan, dopamine
Recurrent headaches
Surgery in past 14 days
<16
MAIO
SSRI can be used when preggers at the lowest effective dose. Except
Which SSRI has Contradictions of heart defects in fetus
Paroxetine
Pre ECT Workup
Chest x ray
ECG
urine analysis
Cbc
Blood urea
Electrolyte
And Discontinue this med
Benzo
Stops the seizures
Type of amnesia associated with ECT
Retrograde
Leading up to event and event itsefl
Low frequency transcranical magnetic stimulation may be used for seizures patients - Not High frequency.
What is the only Contradictions to this procedure…
Metal implants, deep brain, cochlear implants.
Are symptoms of major depressive disorder enough to interfere with a person’s social or job function
Yes
