Depression Flashcards
What are some drugs that can contribute to depression?
- Beta blocker
- CCBs
- Oral contraceptives
- Steroids
- ALL ANTIEPILEPTIC DRUGS
- Opioids
- Stimulants
What is the major BBW on antidepressants?
Increased risk of suicide in children and young adults up to 24 years old
What is AUVELITY?
The only oral NMDA receptor antagonist approved for treatment of MDD in adults (dextromethorphan + bupropion)
What are CI to AUVELITY?
- Seizure disorder (has bupropion)
- Eating disorder
- Within 14 days of MAOIs
- Elevated blood pressure + HTN
- Serotonin syndrome
What should you do if a patient has a 50% reduction in symptoms after 4 weeks of antidepressant therapy?
Continue the patient and reevaluate at weeks 6, 8, and 12
What should you do if a patient has persistent symptoms after 4-8 on an adequate dose of an antidepressant?
Switch to an alternative AD, augment with an alternative MOA AD, SGA, psychotherapy
What should you do if a patient has a partial or no response 1-4 weeks after starting an antidepression?
Assess adherence
Increase dose if possible
Consider ECT
What can a patient expect on their first week of an antidepressant?
Things get WORSE
- Increased anxiety
- Improved sleep/appetite
- N/V, diarrhea
What can a patient expect on weeks 1-3 of an antidepressant?
- Increased activity, sex drive, self care, memory
- Thinking and movement more normal
- Sleeping and eating more normal
What can a patient expect on weeks 2-4 of an antidepressant?
- Relief of depressed mood
- Thoughts of suicide begin to subside
SSRI pearls
- Insomnia or sedation (take in the morning/switch for insomnia)
- Sexual dysfunction (switch or bupropion or other)
- Serotonin syndrome (mental changes, neuromuscular issues, GI)
- QTc, torsades
- Bleeding risk
- Discontinuation syndrome (except fluoxetine)
- More likely energy boosting than sedating
Citalopram
SSRI
- QTc warning from FDA -> avoid in older adults
- ODT available
Escitalopram
SSRI
- Isomer of citalopram
- Does NOT have QTc or dose warning
Fluvoxamine
SSRI
- Not very used
- Caution in elderly
- Many 1A2 interactions
- One of the most sedating
- Can be anticholinergic (less tolerable)
Fluoxetine
SSRI
- Long half life
- Once weekly admin available
- Liquid available
- Diminish appetite, weight loss possible
Paroxetine
SSRI
- Bone fracture
- Don’t use in older adults, very sedating
- Don’t use in pregnancy
- Very anticholinergic
- Short half life -> you feel it if you miss a dose
Sertraline
SSRI
- Well tolerated, efficacious
- Has concentrate that can ONLY mixed with water
What is fluvoxamine’s only FDA approved use?
OCD
What is citalopram’s only FDA approved use?
MDD
What is escitalopram FDA approved for?
MDD, GAD
What is fluoxetine NOT FDA approved for?
GAD, PTSD, SAD
What is paroxetine NOT FDA approved for?
Bulimia nervosa, BPI depressive episodes
What is sertraline NOT FDA approved for?
GAD, Bulimia nervosa, BPI depressive episodes
SNRIs
Tend to be more energy boosting, cause more mania, and cause more HTN than SSRIs
