Depression

Question 1

Which gender is more likely to develop depression?

Answer 1

Females are twice as likely

Question 2

What is the average age of onset of depression?

Answer 2

mid-twenties

Question 3

Psychiatric comorbidities associated with depression

Answer 3

anxiety disorders

substance abuse disorders

Question 4

what causes depression?

Answer 4

exact cause unknown
biological, phychological, and social theories
genetic predisposition, psychological stressors, and biological pathophysiology

Question 5

Symptoms of depression

Answer 5

Depression = SIG E CAPS

Depression, sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide

Question 6

Medical conditions that cause, contribute, or exacerbate depression symptoms

Answer 6

Bipolar
Hypothyroidism
Neoplasms,
Anemia
Infections,
Electrolyte disturbances
Cardiovascular diseases
Neurologic disorders
Psychiatric conditions like substance abuse and anxiety disorders

Question 7

Medications thought to cause, contribute, or exacerbate depression symptoms

Answer 7

BDZs
Narcotics
Corticosteroids
Contraceptives
GRH agonists
Interferon-a
IL-2
Mefloquine
Isotretinoin
Propranolol
Sotalol

Question 8

Serotonin reuptake inhibition symptoms

Answer 8

Anxiety
Insomnia
Sexual Dysfunction
Anorexia
GI upset

Question 9

Norepinephrine reuptake inhibition symptoms

Answer 9

Tremor
Tachycardia
Sweating
Jitters
Elevated BP

Question 10

Dopamine reuptake inhibition

Answer 10

Euphoria
Psychomotor activation
Aggravation of psychosis

Question 11

Alpha-1 blockade symptoms

Answer 11

Orthostatic Hypotension

Dizziness

Question 12

Histamine-1 Blockade symptoms

Answer 12

Sedation

Weight gain

Question 13

Cholinergic blockade symptoms

Answer 13

Dry mouth
Blurry vision
Constipation
Urinary hesitance
(everything dries up)

Question 14

TCA symptoms

Answer 14

5-HT reuptake inhibition
NE reuptake inhibition
Alpha-1blockade
Histamine-1 blockade
Cholinergic blockade

Question 15

SNRI symptoms

Duloxetine, Desvenlafaxine, Venlafaxine

Answer 15

5-HT reuptake inhibition

NE reuptake inhibition

Question 16

SSRI symptoms

Answer 16

5-HT reuptake inhibition

Question 17

Trazodone symptoms

Answer 17

5-HT reuptake inhibition
5-HT2A blockade
Alpha-1 blockade
Histamine-1 blockade
Priapism

Question 18

Bupropion symptoms

Answer 18

DA reuptake inhibition
NE reuptake inhibition
(decreased sexual side effects)

Question 19

Mirtazapine symptoms

Answer 19

Alpha-2 blockade
5-HT2A, 2C, and 3 blockade
Histamine-1 blockade
(Decreased sexual side effects)

Question 20

Antidepressants with lower chance of sexual side effects

Answer 20

Bupropion
Mirtazapine
Nefaxadone

Question 21

Antidepressant contraindicated with seizure disorder

Answer 21

Bupropion

Question 22

Antidepressants which may increase blood pressure at higher doses

Answer 22

SNRIs (venlafaxine, duloxetine, desvenlafaxine)

Question 23

Antidepressant used with caution in hepatic dysfunction

Answer 23

Duloxetine

Question 24

Antidepressant used primarily as a sleep aid

Answer 24

Trazodone

Question 25

Antidepressant that causes priapism (erection lasting >4 hours)

Answer 25

Trazodone

Question 26

Antidepressants with short half-life

Answer 26

``` Nefaxodone (2-4h) Venlafaxine (5h) Desvenlafaxine (7.5h) Duloxetine (9-19h) Bupropion (10-21h) ```

Question 27

Antidepressants with long half-life

Answer 27

``` Fluoxetine has the longest (4-6 days with chronic use. active metabolite = 4-16 days) Citalopram (33h) Mirtazapine (20-40h) Escitalopram (27-32h) Sertraline (27h) Paroxetine (21h) Fluvoxamine (15-26h) ```

Question 28

Symptoms of serotonin symdrome

Answer 28

``` Confusion Restlessness Fever Abnormal muscle movements Hyper-reflexia Sweating Diarrhea Shivering ```

Question 29

First-line antidepressants (Texas)

Answer 29

SSRIs Bupropion SR/XL Mirtazapine SNRIs

Question 30

Factors in selecting antidepressant

Answer 30

Side-effect profile (acceptable to patient) Patient's response to antidepressant therapy (previous therapy of 1* relative's response) Potential interactions (drug-drug, drug-state) Comorbid psychiatric conditions Potential for OD

Question 31

How long does an antidepressant take to work?

Answer 31

2-4 weeks for initial | 6-8 weeks for full effects

Question 32

Managing partial responses

Answer 32

Extend medication trial/use higher doses Add another medication generally not used as an antidepressant (lithium, T3, aripipraxole) Combination therapy with another antidepressant Switch to another antidepressant therapy

Question 33

How long should therapy be continued after treating the 1st depressive episode?

Answer 33

4-9 months | Typical episode lasts 6+ months

Question 34

Symptoms of withdrawal

Answer 34

``` sleep disturbances anxiety fatigue mood changes malaise GI disturbances Confusion Possible depressive relapse or recurrence ```

Question 35

Antidepressants with greatest reproductive safety data (safe for pregnant/nursing women)

Answer 35

fluoxetine citalopram TcAs

Question 36

antidepressants used for geriatric depression

Answer 36

``` SSRIs first line Alternatives: bupropion venlafaxine nefazodone mirtazapine ```

Question 37

Antidepressants used for pediatric depression

Answer 37

SSRIs (may cause behavior activation such as impulsivity, silliness, daring conduct, and agitation) AVOID DESIPRAMINE

Question 38

Antidepressants with narrow therapeutic indices (easier to OD)

Answer 38

TCAs and MAOIs