Depression Flashcards

1
Q

What is the treatment guidelines for depression?

A

Consider CBT and then + SSRI or TCA
SNRIs
If no response, consider TCAs,
moclobemide, irreversible MAOIs,
low-dose amisulpride (seek specialist
advice)

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2
Q

What is the risk with people under 25?

A

increased risk of suicide and SSRI’sc can cause over excitement, suicidal thoughts and tendencies and agression, so review after 1 week and regularly
DONT give TCA as toxic in overdose

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3
Q

What are the classifications of depressions?

A

subthreshold depression - <5 symptoms
mild - 1 or 2 more than 5 or 5
moderate - more then 6 symptoms
severe- affecting function and majority symptoms

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4
Q

What questionnaire as part of diagnosis?

A

DSM-IV (9 characteristics)

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5
Q

How are antidepressants stopped?

A

if taken:
<8 weeks = taper over 1 to 2 wks
if 6- 8 months - taper over 4 to 8 weeks
if long term use - then taper 1/4 dose every 6-8 months and monitor for withdrawal symptoms

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6
Q

How are SSRIs changed to TCA ?
vice versa

A

reduce dose of original drug and slowly increase dose of new drug over a 2 to 4 week period

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7
Q

How is MAOis changed into SSRIs or TCA’s? and vice versa

A

TCA/SSRI’s can be started after 3 weeks of last MAOi dose
for fluoxetine (long half life) after 5 weeks

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8
Q

What are the examples of SSRI’s

A

Sertraline
citalopram, escitalopram
fluoxetine, paroxetine , dapoxetine
fluvoxamine
vortiovexetine

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9
Q

What are the common SE of SSRI’s?

A

Gi discomfort
GI bleeds
Seizure threshold lowered
QT prolongation (cital + escital)
Erectile dysfunction
sleep disturbances
serotonin syndrome

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10
Q

When should monitoring of antidepressants be?

A

1 to 2 weeks after starting
at 4 weeks - if no improvement then increase dose or change drug
no changes usually until after 6 to 8 weeks if there’s no issues

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11
Q

What drugs can increase risk of serotonin syndrome?

A

Lithium
St johns wort
sumatriptan
MAOI’s
Tramadol

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12
Q

what are the symptoms of serotonin syndrome?

A

shivering
convulsions
tremors
restlessness
hyperthermia
come and death

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13
Q

What is the treatment of serotonin syndrome?

A

discontinuation of the serotonergic agent, support, sedation with benzodiazepines, and observation for at least 6 hours

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14
Q

What are the common interaction for SSRI’s?

A

(fluox+parox) with TCA = inhibit metabolism of TCA’s so TCA toxicity
(cital+esc) with lithium = prolonged QT
(fluox+parox) with tamoxifen = lower efficacy of tamoxifen
with NSAIDS and antiplatelets = increased risk of bleeds

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15
Q

What electrolyte disturbances can SSRI’s and TCA’s cause?

A

hyponatraemia

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16
Q

What are the examples of SNRI’s?

A

venlafaxine
duloxetine
Bupropion hydrochloride
bupropion + naltrexone

17
Q

What are the SE of venlafaxine?

A

arrhythmias, ^BP, ^HR
nausea
headache

18
Q

What are the CI for Venlafaxine and duloxetine?

A

venlafax- arrhythmias and uncontrolled hypertension
dulox- hepatic impairement and CrCl <30ml/min

19
Q

What other indication may duloxetine be used for?

A

urinary retention
dose - 20mg BD initially then 40mg bd

20
Q

What are the SE of duloxetine?

A

appetite decreased
anxiety
constipation
diarrhoea
asthenia(weakness)
confusion
chills

21
Q

What are the examples of Atypical antidepressants?

A

mirtazapine and trazadone

22
Q

What are the SE of mirtazapine?

A

sedation
increased appetite
confusion
GI discomfort

23
Q

What are the SE of Trazadone?

A

Abnormal appetite, sedation and drowsiness

24
Q

What counselling is important for mirtazapine?

A

If pt develops - infection symptoms, fever, sore throat any time during treatment see GP so they could do blood count to test if blood dyscrasia has occured

25
What are the examples of TCA's?
amitriptyline, nortrityline clomipramine, impiramine, trimpiramine, lofempramine dosulepin doxepin
26
What are the common SE of TCA's?
sedation (amitrip) weight gain ( blocks histamine) postural hypotension QT interval prolongation dry mouth erectile dysfunction constipation seizure threshold lowered urinary retention cardiac conduction abnormalaties
27
Why is alcohol contraindicated with TCA's?
TCA increase effects of alcohol and cause repiratory depression
28
Why are TCA's CI in heart disease?
causes arrhythmias and dangerous in over dose
29
What are the symptoms of TCA toxicity?
excitement delirium convulsions dry mouth and dry skin blurred vision
30
What is the treatment for TCA toxicity?
activated charcoal - to prevent further absorption diazepam - convulsions O2 and NaHCO3 - hypoxia and acidosis
31
What are the common interactions for TCA's?
all MAOIs- severe toxic reaction (wait 3 weeks after dose ) lithium - ^ risk of neurotoxicity terbinafine - ^ exposure to amitrip (adjust dose) adrenaline/epinephrine - ^ effects of adrenaline (^BP and abnormal heart rhythm)
32
When should TCA's be taken?
At night due to sedative effects
33
What are TCA's contraindicated in?
heart disease/ block arrhythmias severe hepatic/ renal impairement manic phase of bipolar with MAOI's wait 14 days at least
34
What are examples of MAOI's
irreversible inhibitors of MAO-A and B - isocarboxazid, phenelzine, tranycypromine seligiline (MAO-B) moclobemide (reversible MAO-A)
35
What is the symptoms of the cheese reaction with MAOI's?
throbbing headache hypertensive crisis haemorrhage
36
what are the common interactions of MAOI's
decongestants, amphetamine they reduce metabolism of opiods,alcohol and barbituates TCA's severe toxic reaction adrenaline - hypertensive crisis carbamazepine= severe toxic reaction risk
37
How long do MAOI adverse reaction taken to diminish?
Moclobemide - effects will finish when administration stops for irreversible MAOI's it can take upto 5 weeks
38
What is the treatment for MAOI overdose?
if hypertension - phentolamine hypotension - posture mania - chlorpromazine
39
What are 10 SE of amitriptyline?
Dry mouth nausea orthostatic hypotension reduced libido photosensitivity visual disturbances urinary retention palpitations sedation tachycardia