Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CNS 🧠 > Depression > Flashcards

Depression Flashcards

1
Q

Goal of antidepressants

A

Target psychomotor and physiological changes e.g. loss of appetite and sleep disturbances
Improvement in sleep- usually first benefit of therapy
Used for moderate to severe depression, in addition to dysthymia (lower grade chronic depression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ECT (electroconvulsive treatment)

A

Can be used in severe depression if 2 week onset of antidepressant therapy would may result in harm for the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

First line for depression

A

SSRIs

Better tolerated
Safer in overdose
In patients with unstable angina or those who have had a recent MI- sertraline found to be safe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

TCAs

A

Similar efficacy to SSRIs
More likely to be discontinued due to side effects: sedating, anti-muscarinic SE and cardiotoxic
Toxicity in overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MAOIs

A

Avoid tyramine-rich foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How long to wait before considering switching antidepressant?

A

4 weeks (6 weeks in the elderly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Following remission, how long should treatment be continued for?

A

At the same dose for at least 6 months (12 months in elderly)
If they have a history of recurrent depression, they should receive maintenance therapy for at least 2 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hyponatraemia

A

Most common with SSRIs than with other antidepressants

Should be considered in all patients who develop drowsiness, confusion or convulsions while taking an antidepressant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Suicidal thoughts and behaviour

A

Children, young adults and those with a history of suicidal behaviour are particularly at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Symptoms of serotonin syndrome

A

NEUROMUSCULAR HYPERACTIVITY: tremor, hyperreflexia, clonus, myoclonus, rigidity

AUTONOMIC DYSFUNCTION: tachycardia, blood pressure changes, hyperthermia, shivering, diarrhoea

ALTERED MENTAL STATE: agitation, confusion, mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Failure to respond

A

FTR to initial SSRI treatment- increase in dose, switch to a different SSRI or mirtazapine.

Other 2nd lines are lofepramine, moclobemide, reboxetine. Other TCAs and venlafaxine should only be considered in severe depression and MAOIs should only be initiated by specialists.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of acute anxiety

A

Benzodiazepine or busiprone hydrochloride

For chronic (longer than 4 weeks duration) may be suitable to use an antidepressant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of Generalised Anxiety Disorder

A

SSRI- escitalopram, paroxetine
SNRI- Duloxetine, venlafaxine
If these are not tolerated, pregabalin can be considered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treating panic disorder, OCD, PTSD and phobic states such as social anxiety disorder

A

1st line- SSRIs
2nd line in panic disorder (unlicensed)- clomipramine hydrochloride or imipramine hydrochloride

Moclobemide- can be used in social anxiety disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sedative tricyclic antidepressants

A 
Amitriptyline
Clomipramine
Dosulepin
Doxepin
Mianserin
Trazodone
Trimipramine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Less sedative tricyclic antidepressants

A

Imipramine
Lofepramine
Nortriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lofepramine

A

Lowest incidence of side effects
Less dangerous in overdose
But hepatic toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Imipramine

A

More antimuscarinic side effects than other TCAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most dangerous in overdose

A

Amitriptyline and dosulepin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Administration of TCAs

A

Long half life so only once at night administration is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

TCAs and children

A

Studies show that TCAs are not effective for treating depression in children

22
Q

STOPP criteria for TCAs in the elderly

A

Those with dementia, narrow angle glaucoma, cardiac conduction abnormalities, prostatism or history of urinary retention

23
Q

Stimulant action of MAOIs

A

Tranylcypromine has a greater stimulant action than phenelzine or isocarboxazid so is more likely to cause a hypertensive crisis.

24
Q

Hepatotoxicity in MAOIs

A

Isocarboxazid and phenelzine are more likely to cause hepatotoxicity than tranylcypromine.

25
Q

Patients who are said to respond best to MAOIs

A

Phobic patients and depressed patients with atypical, hypochondriacal or hysterical features

26
Q

Response to MAOI treatment

A

May take up to 5 weeks

27
Q

How long after stopping MAOI treatment can treatment with other antidepressants be commenced?

A

2 weeks

3 weeks if starting clomipramine or imipramine

28
Q

How long after stopping an MAOI can another be started?

A

2 weeks (then start at a reduced dose)

29
Q

How long after stopping a TCA can an MAOI be started?

A

At least 7-14 days (3 weeks in the case of clomipramine or imipramine)

30
Q

How long after stopping an SSRI can an MAOI be started?

A 
1 week
(At least 5 weeks in the case of fluoxetine)
31
Q

Flupentixol (thixanthene)

A

Antidepressant properties at low doses

Also used for the treatment of psychoses

32
Q

Vortioxetine

A

Recommended in patients who have responded inadequately to 2 antidepressants within the current episode

33
Q

Tryptophan

A

Treatment-resistant depression
Withold treatment if patient experiences any symptoms of eosinophilia myalgia syndrome (EMS) until the possibility of EMS is excluded.

34
Q

Agomelatine

A

Liver function tests

35
Q

Monoamine oxidase inhibitors

A

Risk of postural hypotension and hypertensive episodes- monitor BP

36
Q

MAOI withdrawal symptoms

A 
Agitation
Irritability
Ataxia
Movement disorders
Insomnia
Drowsiness
Vivid dreams
Cognitive impairment
Slowed speech
37
Q

How long within stopping antidepressants can withdrawal symptoms present?

A

5 days

38
Q

When is risk of developing withdrawal to antidepressants highest?

A

If they have been taking for longer than 8 weeks

39
Q

How long does the danger of interaction between MAOIs and tyramine-rich foods last for after discontinuation?

A

2 weeks

Avoid alcoholic or low alcohol drinks in addition to food that may be going off or stale

40
Q

Moclobemide

A

Claimed to cause less potentiation of tyramine than other traditional irreversible MAOIs such as phenelzine, tranylcypromine and isocarboxazid but should still avoid consuming lots of mature cheese, yeast extracts and fermented soya bean products, etc.

41
Q

Contraindications of SSRIs

A

Poorly controlled epilepsy

If patient enters the manic phase

42
Q

Sexual dysfunction with SSRIs and SNRIs

A

May persist even after treatment has stopped.

43
Q

SSRI withdrawal symptoms

A 
GI disturbances
Headache
Anxiety
Electric shock sensation in the head, neck, spine
Tinnitus
Sleep disturbances
Fatigue
Influenza-like symptoms
Sweating
44
Q

Citalopram/escitalopram oral drops

A

Can be mixed with water, orange juice or apple juice before taking

45
Q

SSRIs

A

Counsel on effect on driving and skilled tasks

46
Q

Paroxetine and venlafaxine

A

Associated with higher risk of withdrawal symptoms

47
Q

Duloxetine in pregnancy

A

Avoid if stress urinary incontinence but if not, use only if potential benefit outweighs risk

48
Q

Contraindication to venlafaxine

A

Uncontrolled hypertension

49
Q

Trazodone

A

Serotonin uptake inhibitor

50
Q

Amitriptyline

A

Associated with a higher rate of fatality with overdose
Treatment should be stopped if patient enters manic phase
TCAs should be prescribed in limited quantities at one time due to the potential cardiogenic and epileptogenic effects in overdose.
Max 2 weeks of 75mg daily should be considered for patients at increased risk of suicide.

51
Q

TCA overdose symptoms

A 
Dry mouth
Coma
Hypotension
Hypothermia
Hyperreflexia
Convulsions
Respiratory failure
Arrhythmias
Dilated pupils and urinary retention

CNS 🧠 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions