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3 > Depression > Flashcards

Depression Flashcards

1
Q

first line antidepressant?

A
  1. mirtazapine
  2. SSRI
  3. SNRI
  4. bupropion
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2
Q

non-pharm for depression?

A

sleep hygiene
psychotherapy
neurostimulation (ECT, rTMS) - reserve for severe depression

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3
Q

what is considered adequate trial?

A

adequate dose + adequate duration (4-8w)

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4
Q

why is there a delayed response?

A

due to gradual downregulation of pre-synpatic autoreceptors in synapse, which in turn facilitate neurotransmitter release

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5
Q

how long does it take for physical sx (eg sleep & appetite) to improve?

A

1-2 weeks

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6
Q

how long does it take for mood sxs to improve?

A

longer, 4-8 weeks

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7
Q

how long should anti-depressants be continued for?

A

another 4-9 months after acute treatment (total 6-12 months)

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8
Q

why does anti-depressants take so long to have an effect?

A

inhibition of pre-synpatic autoreceptors take a long time
inhibit pre-synaptic autoreceptors –> inhibit release of neurotransmitted

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9
Q

most antidepressants have short half life, which anti-depressants have long half life?

A

fluoxetine, vortioxetine

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10
Q

what TCAs are there?

A

Amitriptyline –> Nortriptyline
Imipramine –> Desipramine
Dothiepin (Dosulepin)
Clomipramine

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11
Q

MOA of TCA

A

Blocks reuptake of NE & 5HT.
Anticholinergic
H1 & alpha-adrenergic antagonism

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12
Q

SE of TCA

A

GI & sexual dysfunction,
Anticholinergic, Sedation,
Weight gain , Orthostatic, BP
Arrhythmias, Seizure,
Fatal on overdoses

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13
Q

what SSRI are there?

A

Fluoxetine –>Norfluoxetine
Fluvoxamine
Escitalopram/Citalopram
Sertraline
Paroxetine

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14
Q

MOA for SSRI?

A

Blocks reuptake of 5HT
selectively.

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15
Q

side effects of SSRI?

A

GI & sexual dysfunction.
Headache, transient nervousness during initiation
Insomnia: Fluoxetine
Hyponatremia (SIADH)
Bleeding risk; EPSE

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16
Q

which SSRI is the most anticholinergic, sedating, increase weight & short half life (withdrawal)?

A

paroxetine

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17
Q

which cause QTc prolongation at high dose in elderly

A

escitalopram, citalopram

18
Q

what NaSSA are there?

A

mirtazapine

19
Q

side effects of NaSSA

A

Somnolence, increase appetite,
weight gain

19
Q

MOA of mirtazapine

A

alpha- 2 adrenoceptor antagonist
increase 5HT & NE
5HT2&3, H1 antagonism

20
Q

what are mirtazapine good for?

A

Reverse GI & sexual SE of SSRI/SNRI.

21
Q

what are NDRI?

A

bupropion

22
Q

MOA of bupropion

A

Blocks reuptake of NE & DA

23
Q

SE of bupropion

A

Seizure,
Insomnia, Psychosis
Not suitable for eating d/o.

24
Q

what benefit of brupropion

A

decrease sexual SE of SSRI/SNRI
Smoking cessation aid

25
Q

what MAOi are there

A

moclobemide

26
Q

MOA of mocloblemide

A

Reversible
MAOI A (RIMA)

27
Q

adjunct treatment for MDD (antipsychotic)

A

aripiparazole, brexpiparazole, quetapine XR

28
Q

what PRN hypnotics for adjunctive treatment for MDD?

A

benzodiazepines, z-hypnotics (zopiclone, zolpidem), antihistamine (hydroxyzine)

29
Q

dose of fluoxetine?

A

20mg OM, max 80mg

30
Q

dose of mirtazapine?

A

15-45mg, max 45mg

31
Q

can you combine MAOi & SSRI?

A

no, need wash out period when switching

32
Q

precautions in elderly?

A

avcoid TCAs

33
Q

mandatory counselling for </= 24 yo

A

suicidality

34
Q

which antidepressant suitable for underweight?

A

mirtazapine

35
Q

which antidepressent suitable for chronic pain/neuropathy?

A

duloxetine

36
Q

which anti-depressants has fewer CYP interactions?

A

mirtazapine, escitalopram, venlaflazine, desvenlafazine, vortioxetine

37
Q

what is antidepressants discontinuoation syndrome?

A

due to abruptly stopping treatment esp paroxetine, venlaflaxine (short t1/2)

38
Q

presentation of antidepressants discontinuation syndrome?

A

FINISH
Flu like symptoms (lethargy, fatigue, headache, achiness,
Insomnia (with vivid dreams or Nausea (sometimes vomiting),
Imbalance (dizziness, vertigo, light
headedness),
Sensory disturbances (“burning,” “tingling,”, “electric like” sensations)
Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness).

39
Q

how to avoid Antidepressants Discontinuation Syndrome

A

gradual tapering

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