Depression

Question 1

Depression Diagnosis

Answer 1

DSM-5 Criteria - at least 5 of the following symptoms during the same two week period (must include depressed mood or diminished interest/pleasure)
M SIG E CAPS
Mood - depressed
Sleep - increased/decreased
Interest/pleasure - diminished
Guilt or feelings of worthlessness
Energy - decreased
Concentration - decreased
Appetite - increased/decreased
Psychomotor agitation or retardation
Suicidal ideation

Question 2

Select drugs that cause or worsen depression

Answer 2

ADHD medication (atomoxetine)
Analgesics (Indomethacin)
Antiretrovirals (efavirenz, rilpivirine)
Cardiovascular medications (beta blockers esp propranolol)
Hormones (anabolic steroids, hormonal contraceptives)
Antidepressants, Benzodiazepines, Systemic steroids, Interferons, Varenicline, Ethanol

Question 3

Medical conditions that contribute to depression

Answer 3

Stroke, Parkinson disease, dementia, multiple sclerosis, hypothyroidism, low vitamin D levels, metabolic conditions, malignancy, overactive bladder and infectious diseases

Question 4

Celexa

Answer 4

Citalopram

Max dose 40 mg/day and elderly 20 mg/day

Question 5

Lexapro

Answer 5

Escitalopram

Max dose 20 mg/day and elderly 10 mg/day

Question 6

Prozac, Sarafem

Answer 6

Fluoxetine - most activating
Sarafem used for PMDD only
+ olanzapine (Symbyax)

Question 7

Paxil, Brisdelle

Answer 7

Paroxetine - most sedating

Brisdelle for moderate-severe vasomotor symptoms associated with menopause

Question 8

Zoloft

Answer 8

Sertraline

Preferred in patients with cardiac risk

Question 9

SSRI Warnings/Side Effects

Answer 9

QT prolongation, SIADH/hyponatremia, fall risk, bleeding

sexual side effects, somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, headache

Question 10

Fluoxetine and Paroxetine

Answer 10

CYP2D6 inhibitors
Tamoxifen requires conversion to its active form by CYP2D6; decreased tamoxifen effectiveness occurs
Venlafaxine is preferred

Question 11

Effexor XR

Answer 11

Venlafaxine
Depression, generalized anxiety disorder, panic disorder, social anxiety disorder
Max dose: 375 mg/day IR

Question 12

Cymbalta

Answer 12

Duloxetine

Depression, peripheral neuropathy, fibromyalgia, GAD, chronic musculoskeletal pain

Question 13

Pristiq

Answer 13

Desvenlafaxine

Question 14

SNRI Warnings/Side Effects

Answer 14

SIADH/hyponatremia, fall risk, bleeding
Similar to SSRI + Side effects due to NE: increased HR, dilated pupils, dry mouth, excessive sweating and constipation, increased BP

Question 15

Two main categories of TCA

Answer 15

Secondary amines - selective for NE

Tertiary amines - more effective but have worse side effect profile

Question 16

TCA Mechanism of Action

Answer 16

Inhibit NE and 5-HT reuptake and also block ACh and histamine receptors

Question 17

Elavil

Answer 17

Amitriptyline (tertiary amine)

Question 18

Doxepin

Answer 18

for depression all are generic (tertiary amines)

SIlenor is for insomnia

Question 19

Pamelor

Answer 19

Nortriptyline (secondary amine)

Question 20

TCA Side effects

Answer 20

Cardiotoxicity - QT prolongation with overdose (monitor for suicidal ideation can quickly lead to fatal arrhythmias), orthostasis
Anticholinergic - dry mouth, blurred vision, urinary retention, constipation, weight gain, risk of falls

Question 21

Wellbutrin SR, Wellbutrin XL

Answer 21

Bupropion - do not exceed 450 mg/day due to seizure risk

Zyban - for smoking cessation
+ naltrexone - for weight management

Question 22

Bupropion Contraindications

Answer 22

Seizure disorder, history of anorexia/bulimia, do not use with IV methylene blue, linezolid, MAO inhibitors or other forms of bupropion

Question 23

Bupropion Side effects

Answer 23

Dry mouth, CNS stimulation (insomnia, restlessness), tremors/seizures (dose-related), weight loss
Sexual dysfunction is rare