depression Flashcards
What are the 3 goals of depression treatment?
- Reduce/remove signs/symptoms
- Restore occupational/psychosocial function
- Reduce recurrence/relapse
What must you have 4 of within the same 2 week period IN ADDITION to at least 1 of the 2 defining symptoms?
4 of the following 7:
- Weight (+/- 5% in month)
- Sleep (insomnia/hypersomnia)
- Fatigue/lack of energy
- Psychomotor agitation
- Feelings of worthlessness/guilt
- Diminished ability to think
- Recurrent thoughts of death/suicide
What must you have 1 OR both of to be diagnosed with depression?
#1 - depressed mood most of day #2 - markedly diminished interest in normally loved activities
In addition to the 1 of 2 and the 4 of 7 - what 3 criteria must be met for final diagnosis of depression?
- 1 of 2 + 4 or more in same 2 weeks
- Change in previous function
- Not attributed to drugs or bereavement
What are 7 types of depression?
- MDD
- Dysthymic depression
- Bipolar
- Substance-abuse induced
- Seasonal awareness
- Post-partum
7, pre-menstrual dysphoric
What are the neurotransmitters that regulate physiological symptoms of depression?
- Dopamine
- Norepinephrine
- Serotonin
What are the 4 classes of anti-depressant drugs?
- TCA’s (tricyclic antidepressants)
- MAOI’s (Monoamine Oxidase Inhibitors)
- SSRI’s (Selective Serotonin Reuptake Inhibitors)
- New Generation Antidepressants
What is the MOA for TCA’s?
Inhibit the reuptake of:
Noriepinephrine
Serotonin (5-HT receptor)
What are 5 TCA drugs?
NADIP
- Nortriptyline (migraines)
- Amitriptyline (fibromylagia)
- Doxepin
- Imipramine (cardiac issues @ high doses)
- Protriptyline (low sedation; CNS stimulant)
NOT FOR MIDTERM 2
What are the side effects of TCA?
Anticholinergic/Antihistamine like: dry mouth blurred vision urine hesitancy constipation drowsiness
What is the MOA for MAOI’s?
Block degradation of the following by inhibiting Mono Amine Oxidase enzyme thereby increasing volume of the following:
- Dopamine
- Noriepinephrine
- Serotonin
What is the main ADVERSE effect of MAOI’s?
Cheese Syndrome/Hypertensive crisis
from inability to breakdown tyramine
NOT FOR MIDTERM 2
What are the side effects of MAOI’s?
similar to TSA’s:
- weight gain
- nausea/dry mouth
- constipation
- insomnia
- orthostatic hypotension, dizzy, headache
NOT FOR MIDTERM 2
What are the adverse effects of TCA?
Cardiac Issues:
tachycardia
arrhythmias
orthostatic hypotensions
What are the 3 MAOI’s?
PIT
- Phenelzine (most commonly used)
- Isocarboxazid
- Tranylcypromines
What is the MOA for SSRI’s?
Selective Serotonin Uptake Inhibitor
NOT FOR MIDTERM 2
What are the side effects of SSRI’s?
nervousness agitation/anxiety insomnia with night sweats nausea/diarhhea headaches SEXUAL dysfunction
What are the 4 SSRI drugs to know?
- Fluoxetine/Prozac (eating disorder/safe in pregn)
- Sertraline/Zoloft (diarrhea)
- Paroxetine/Paxil (sedation/weight gain)
- Citalopram/Celexa (minimal SE, SEXUAL dysf)
How many NEW generation antidepressants?
5 - TNVBM
- Trazodone
- Nefazodone
- Venlafaxine
- Buproprion
- Mirtazapine
What is the MOA of trazadone?
Inhibits reuptake of:
- Noriepinephrine
- Serotonin
What is the MOA of nefazodone?
Inhibits reuptake of:
- Noriepinephrine
- Serotonine
What is the MOA of venlafaxine?
Inhibits the reuptake of:
- Dopamine
- Noriepinephrine
- Serotonin
What is the MOA of Buproprion?
Inhibits the reuptake of DOPAMINE
What is the MOA of Mirtazapine?
Stimulates release of:
- Noriepinephrine
- Serotonin
What does trazodone cause as a side effect?
Severe sedation - even at low levels and high doses are required for therpeutic effects
What is nefazodone named?
The “calming” antidepressant - good for depression with anxiety or insomnia
What is special about venlafaxine?
Inhibits reuptake of all 3 neurotransmitters AND causes weight loss with VIVID dreaming
What is special about mirtazapine?
stimulates RELEASE of:
noriepinephrine
serotonin
AND lower dose causes MORE sedation
What else is buproprion used for?
Cessation of Smoking under Zyban
What is the etiology of depression?
Imbalance of Dopamine, NE & Serotonin from:
- Genetics
- Catastrophic Event
- Environmental Factors
