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Therapeutics 2 > Depression > Flashcards

Depression Flashcards

1
Q

Which gender is more likely to develop depression?

A

Females are twice as likely

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2
Q

What is the average age of onset of depression?

A

mid-twenties

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3
Q

Psychiatric comorbidities associated with depression

A

anxiety disorders

substance abuse disorders

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4
Q

what causes depression?

A

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

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5
Q

Symptoms of depression

A

Depression = SIG E CAPS

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

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6
Q

Medical conditions that cause, contribute, or exacerbate depression symptoms

A 
Bipolar
Hypothyroidism
Neoplasms,
Anemia
Infections,
Electrolyte disturbances
Cardiovascular diseases
Neurologic disorders
Psychiatric conditions like substance abuse and anxiety disorders
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7
Q

Medications thought to cause, contribute, or exacerbate depression symptoms

A 
BDZs
Narcotics
Corticosteroids
Contraceptives
GRH agonists
Interferon-a
IL-2
Mefloquine
Isotretinoin
Propranolol
Sotalol
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8
Q

Serotonin reuptake inhibition symptoms

A 
Anxiety
Insomnia
Sexual Dysfunction
Anorexia
GI upset
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9
Q

Norepinephrine reuptake inhibition symptoms

A 
Tremor
Tachycardia
Sweating
Jitters
Elevated BP
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10
Q

Dopamine reuptake inhibition

A

Euphoria
Psychomotor activation
Aggravation of psychosis

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11
Q

Alpha-1 blockade symptoms

A

Orthostatic Hypotension

Dizziness

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12
Q

Histamine-1 Blockade symptoms

A

Sedation

Weight gain

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13
Q

Cholinergic blockade symptoms

A 
Dry mouth
Blurry vision
Constipation
Urinary hesitance
(everything dries up)
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14
Q

TCA symptoms

A 
5-HT reuptake inhibition
NE reuptake inhibition
Alpha-1blockade
Histamine-1 blockade
Cholinergic blockade
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15
Q

SNRI symptoms

Duloxetine, Desvenlafaxine, Venlafaxine

A

5-HT reuptake inhibition

NE reuptake inhibition

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16
Q

SSRI symptoms

A

5-HT reuptake inhibition

17
Q

Trazodone symptoms

A 
5-HT reuptake inhibition
5-HT2A blockade
Alpha-1 blockade
Histamine-1 blockade
Priapism
18
Q

Bupropion symptoms

A

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

19
Q

Mirtazapine symptoms

A

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

20
Q

Antidepressants with lower chance of sexual side effects

A

Bupropion
Mirtazapine
Nefaxadone

21
Q

Antidepressant contraindicated with seizure disorder

A

Bupropion

22
Q

Antidepressants which may increase blood pressure at higher doses

A

SNRIs (venlafaxine, duloxetine, desvenlafaxine)

23
Q

Antidepressant used with caution in hepatic dysfunction

A

Duloxetine

24
Q

Antidepressant used primarily as a sleep aid

A

Trazodone

25
Q

Antidepressant that causes priapism (erection lasting >4 hours)

A

Trazodone

26
Q

Antidepressants with short half-life

A 
Nefaxodone (2-4h)
Venlafaxine (5h)
Desvenlafaxine (7.5h)
Duloxetine (9-19h)
Bupropion (10-21h)
27
Q

Antidepressants with long half-life

A 
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)
28
Q

Symptoms of serotonin symdrome

A 
Confusion
Restlessness
Fever
Abnormal muscle movements
Hyper-reflexia
Sweating
Diarrhea
Shivering
29
Q

First-line antidepressants (Texas)

A

SSRIs
Bupropion SR/XL
Mirtazapine
SNRIs

30
Q

Factors in selecting antidepressant

A

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

31
Q

How long does an antidepressant take to work?

A

2-4 weeks for initial

6-8 weeks for full effects

32
Q

Managing partial responses

A

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

33
Q

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

A

4-9 months

Typical episode lasts 6+ months

34
Q

Symptoms of withdrawal

A 
sleep disturbances
anxiety
fatigue
mood changes
malaise
GI disturbances
Confusion
Possible depressive relapse or recurrence
35
Q

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

A

fluoxetine
citalopram
TcAs

36
Q

antidepressants used for geriatric depression

A 
SSRIs first line
Alternatives:
bupropion
venlafaxine
nefazodone
mirtazapine
37
Q

Antidepressants used for pediatric depression

A

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

AVOID DESIPRAMINE

38
Q

Antidepressants with narrow therapeutic indices (easier to OD)

A

TCAs and MAOIs

Therapeutics 2 (11 decks)

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