Depression Flashcards
depression disorders
MDD
adjustment disorder and depressed mood
seasonal affective disorder
substance-ind mood disorder
depression causes medical
hypothyroidism
anemia
HIV/AIDS
autoimmune disease
CV disease
neurologic disorders (epilepsy, huntingtons, parkinsons, alzheimers, post-stroke)
depression causes med-induced
BBs, CCBs, OCs, steroids, topiramate, levetiracetam, opioids, stimulants
MDD DSM5 criteria for dx
5 or more of the following in same 2-eek period
1. depressed mood most of day, nearly every day
2. marked dec in pleasure and interest in all or almost all activities
3. significant weight loss (>5% in 1mo)
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation
6. feeling worthlessness or excessive or inappropriate guilt
7. dec ability to think or concentrate
8. recurrent thoughts of death
SSRIs includes …
citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
SNRIs includes …
desvenlafaxine, duloxetine, levominacipran, venlafaxine, milnacipran
serotonin modulators includes …
trazodone, fefazodone, vilazodone, vortioxetine
TCAs includes …
amitriptyline, nortriptyline, protriptyline, doxepin, amoxipine, clomipramine, desipramine, trimipramine, maprotiline
MAO-i s includes …
phenelzine, tranylcypromine
rasagiline, selegiline
misc ADs
brexanolone, bupropion, esketamine, mirtazepine
ADs and BPD warning
unopposed use of AD in BPD may precipitate a manic/mixed episode
first line ADs
SSRIs, SNRIs, bupropion, mirtazepine, vorioxetine
an adequate trial is________. After this a pateint can _____
4-8weeks
switching or augmenting w different MOA
D/C SSRi can cause
electric shock sensations (except prozac d/t long half life)
SSRi rare but serious AE
hyponatremia and SIADH. monitor for inc lethargy, AMS, Na <135
SSRis and which serotonergic drugs should not be used due to serotonin syndrome
triptans
fentanyl, tramadol
zofran, reglan
buspar
linezolid
ritonavir
citalopram
MDD
dose adjustments
forms
FDA warngin
> 40mg not recommended
MDD 20mg for : elderly, hepatic impairment, 2C19
FDA - QTc warning
ODT, tab
escitalopram
no dose adjustments or QTc like citalopram does
MDD 10mg for hepatic impairment
fluvoxamine
elderly?
DDI?
use
caution in elderly - most sedating and anticholinergic AE
many DDI via 1A2
only for OCD
fluoxetine
pearls
AE
uses
only approved one for qweek admin
available as liquid
inhibits 2D6 (TCAs), 3A4 (CBZ)
AE: anorexia, anxiety and insomnia
uses: MDD, OCD, bulimia nervosa, panic disorder, PMDD, TRD, BPD-I
paroxetine
pearls
AE
uses
avoid in pregnancy!!
akasthisia
sedating and anticholinergic –> careful in elderly
uses: MDD, OCD, PD, GAD, SAD, PTSD, PMDD, VSM
dose adjustments for severe hepatic and renal impairment
sertraline
uses
MDD, OCD, PD, SAD, PTSD, PMDD
only SSRIs that can be used for GAD
lexapro and paxil
only SSRI indicated for bulimia nervosa and BPI depressive episode
also only med indicated for adolescent depression in down to 8yo
fluoxetine
venlafaxine
use
pearl
MDD, GAD, PD, SAD
take w food
2D6 interactions
BP changes at higher doses
SNRI indicated only for MDD
Levomilnacipran
only SNRI that can be used for panic disorder and social phobia
venlafaxine (other indications include MDD GAD)
TCAs indications
MDD, insomnia, nocturnal enuresis (imipramine)
TCAs AE
“CA” = cardiac adverse effects
switch letters –> “AC” = anticholinergic AE
CV ventricular tachycardia and heart block
cognitive impairment, urinary retention
also…
weight gain
sexual dysfunction
2D6 interactions
TCAs withdrawl s/sx
insomnia
weight gain
abd pain
diarrhea
myalgias
nausea
only TCA indicated for depression AND insomnia
doxepin
MAO-i
switching to MAO-i instructions
after d/c interacting agent, wait 4-5 t1/2 to initiate MAOi
f;uoxetine and vortioxetine have longest t1/2s at 5 and 3 weeks!!
no tyramine!!
monitor BP
AE: postural hypotension, diarrhea, anticholinergic drying effects, sexual dysfunction
MAOis + _______ are a concern for hypertensive crisis
MAOis + _______ are a concern for serotonin syndrome
amphetamines, decongestants, methylphenidate
dextromethorphan
selegiline is available in what dosage forms
po, ODT, TD patch
escitalopram approved for what ages
12+
SSRI options in OCD
fluoxetine, paroxetine, sertraline, fluvoxamine
which TCAs can be used for MDD in peds and what age range
amitriptyline, nortriptyline and doxepin in 12-17 yo
ADs safe to use in pregnanacy
typically SSRis EXCEPT PAROXETINE
what qualifies a pt as refractory/tx resistant depression
and waht are options
non response to 2 separate trials of different ADs of adequate dose and duration
switch, combo, augment
combos include SSRI/SNRI + bupropion/mirtazepine
augmentation: lithiumtriiodothyronine, SGAs
lithium is usually augmentation of
TCAs for major depressive episodes in MDD and BPD
NMS (neuroleptic malignant syndrome)
s/sx causes
DA antagonists
onset 1-3d
HTN, tachyc, hyperthermia, hypersalivation, diaphoresis, pallor, lead pipe rigidity in all muscle groups, hyporeflexia, normal pupils, normal or dec bowel sounds, mental status variable
serotonin syndrome s/sx causes
serotonin agents
onset <12hHTN, tachyc, hyperthermia, hypersalivation, diaphoresis, inc tone in lower extremities, hyperreflexia, dilated pupils, hyperactive bowel sounds, mental status variable
NMS vs SS
NMS onset is much longer than SS (1-3d vs <12h
NMS has muscle rigidity in ALL muscle groups, SS is just lower extremities
SS has dilated pupils and hyperactive bowel sounds. NMS does not
NMS has hyporeflexia, SS has hyperreflexia
