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AI Exam 2 > Depression > Flashcards

Depression Flashcards

1
Q

What vitamin deficiency can cause depression?

A

Vitamin D

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2
Q

What medications can CAUSE Unipolar Depression?

A

-Alcohol
-Steroids
-Benzodiazepines
-Antipsychotis
-Anticonvulsants
-NSAIDs
-CVD drugs
-Caffeine / withdrawal

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3
Q

What are the three symptoms categories of Depression?

A

-Emotional
-Physical
-Cognitive

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4
Q

What are the key symptoms of Depression?

A

-Persistent sadness or low mood
-Marked loss of interests or pleasure
-Lack of energy

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5
Q

What are the associated symptoms of Depression?

A

-Disturbed sleep
-Decreased or increased appetite and/or weight
-Fatigue or loss of energy
-Agitation or slowing of movements
-Poor concentration or indecisiveness
-Feelings of worthlessness or excessive or inappropriate guilt
-Suicidal thoughts or acts

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6
Q

What is the ICD 10 criteria for diagnosis of Depression?

A

At least TWO key symptoms, most days, most of the time for at least 2 weeks, minimum 4 symptoms

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7
Q

What is the DSM IV criteria for diagnosis of Depression?

A

At least ONE of these key symptoms, most days, most of the time at least 2 weeks and minimum 5 symptoms.

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8
Q

NICE (CG90) has divided depression into five grades: What is the sub-threshold grade of depression?

A

Where the person has a few symptoms and feels low, but can still function.

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9
Q

NICE (CG90) has divided depression into five grades: What is the mild grade of depression?

A

Where the person has enough symptoms for a diagnosis but can function reasonably well

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10
Q

NICE (CG90) has divided depression into five grades: What is the moderate grade of depression?

A

Where the person has a range of symptoms and is not coping well

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11
Q

NICE (CG90) has divided depression into five grades: What is the severe grade of depression?

A

Where the person has a full set of symptoms, can’t function and may even suffer from psychotic symptoms too

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12
Q

NICE (CG90) has divided depression into five grades: What is the complex grade of depression?

A

Where the symptoms have failed to improve with treatment and may have psychosis, other symptoms and problems

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13
Q

What should all patients with suspected presentation of depression be offered?

A

STEP ONE
-Assessment
-Support
-Psycho-education
-Active monitoring
-Onward referral for further assessment and intervention

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14
Q

What is the treatment options for mild to moderate depression?

A

STEP TWO
-Low intensity psychological or psychosocial interventions
-Medication
-Onward referral

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15
Q

What is the treatment options for moderate to severe depression?

A

STEP THREE
-Medication
-High-intensity psychological interventions
-Combined treatments and collaborative care
-Onward referrals

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16
Q

What is the treatment options for severe and complex depression?

A

STEP FOUR
-Medication
-High-intensity psychological interventions
-ECT
-Crisis service
-Combined treatments
-Multi-professional and inpatient care

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17
Q

-Guided self help (books and leaflets)
-Being active
-Computer based CBT
Are examples of what type of interventions?

A

Low intensity psychosocial interventions

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18
Q

-Psychological therapies, CBT, Interpersonal therapies, relaxation therapy, anxiety management, mindfulness-related therapies and counselling
-General support and advice.
Are examples of what type of interventions?

A

High intensity psychological interventions

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19
Q

What is ECT?

A

Electroconvulsive therapy for acute severe depression

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20
Q

What is TMS?

A

Transcranial magnetic stimulation

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21
Q

What antidepression doesn’t need to be started low and why?

A

Mirtazapine!

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22
Q

What antidepressant is hard to get to the therapeutic dose due to side effects and poor tolerability?

A

Tricyclics

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23
Q

What combination / augmentation can be used in depression in adults?

A

Lithium, an antipsychotic or another antidepressant

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24
Q

What antipsychotic choices are available for depression?

A

Aripiprazole, Olanzapine, Quetiapine or Risperidone

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25
Q

What drug class is standard first line for depression?

A

SSRI’s - Citalopram, escitalopram, fluoxetine, sertraline

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26
Q

What are some examples of dose dependent SNRI’s?

A

Duloxetine, Venlafaxine

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27
Q

At what dose is venlafaxine a SNRI?

A

150mg/day

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28
Q

Lofepramine and Clomipramine are examples of what class of drug?

A

Tricyclic antidepressants

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29
Q

What SSRI shows discontinuation symptoms?

A

Paroxetine

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30
Q

Amitriptyline, Dosulepin, Doxepin, Imipramine, Nortriptyline and Trimipramine are examples of what type of anti-depressant?

A

Tricyclic

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31
Q

Irreversible inhibition of MAO-A and MAO-B enzymes. Used for more resistant depression and requires a tyramine-free diet, are what drugs?

A

MAOIs
-Isocarboxazid
-Phenelzine
-Tranylcypromine

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32
Q

What drug is a reversible inhibition of MAO-A, lacking the food and drink interactions?

A

Moclobemide

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33
Q

What type of depression is Lithium used for?

A

Bipolar depression

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34
Q

What antidepressants have the highest efficacy and tolerability?

A

-Agomelatine
-Escitalopram
-Vortioxetine

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35
Q

What antidepressants have higher efficacy but lower tolerability?

A

-Amitriptyline
-Mirtazapine
-Paroxetine
-Venlafaxine

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36
Q

What antidepressants have high tolerability but lower relative efficacy?

A

Citalopram, Fluoxetine, sertraline

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37
Q

What antidepressants have lowest efficacy and tolerability?

A

Fluvoxamine, reboxetine, trazodone

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38
Q

When should a SSRI be taken?

A

In the morning

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39
Q

When should mirtazapine be taken?

A

At night

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40
Q

What is a melatonin receptor agonist and improves sleep?

A

Agomelatine

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41
Q

How long can it take for antidepressants to work?

A

2-6 weeks to work then 4-6 for optimum effect

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42
Q

If no improvement can be seen after 4 weeks of a therapeutic dose what should we do?

A

1) Check adherence
2) Switch to another antidepressant

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43
Q

How often should a patient be seen after commencing antidepressant therapy?

A

Every 2-4 weeks for the first 3 months

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44
Q

Were switching from a first like SSRI what should we swap to?

A

Try another SSRI or better tolerated newer-generation antidepressant

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45
Q

If a patients tolerance is the issue with the antidepressant what should we do?

A

Try a different MOA, chemical group or a different drug from the same group

46
Q

If lack of efficacy is the issue with the antidepressant what should we do?

A

Try a different class or mode of action

47
Q

How do we switch between SSRI’s and SNRI’s?

A

Cross-taper
*carefully to avoid serotonin syndrome

48
Q

What drug group can interact with SSRI’s?

A

Tricyclics

49
Q

What antidepressant has a long half life?

A

Fluoxetine

50
Q

How do you swap from fluoxetine to a reversible MAOI?

A

Taper and Stop fluoxetine and wait 5-6 weeks.

51
Q

How do you swap from a non-reversible MAOI to Fluoxetine?

A

A 2 week washout period is required

52
Q

How many failed antidepressants suggests a review of the diagnosis?

A

Two

53
Q

Pt X with PMHx of Depression and takes a SSRI has come into the pharmacy with:
-Restlessness
-Myoclonus
-Tremor and rigidity
-Hyperreflexia
-Shivering / elevated temperature
-Arrhythmias

What is this and what other drugs can cause this?

A

Serotonin Syndrome
-SSRI’s
-Tramadol
-SNRI
Triptans

54
Q

A patient with there first episode of depression, how long should they continue drug therapy for?

A

Six months after recovery at the same dose as this minimises relapse risk

55
Q

A patient with there second episode of depression, how long should they continue drug therapy for?

A

1-2 years may reduce relapse

56
Q

A patient with there third episode of depression, how long should they continue drug therapy for?

A

3-5 years or longer to reduce relapse

57
Q

There is a potential increased risk of suicide within the first __________ of therapy?

A

Month
*NO large studies conducted on this

58
Q

When can withdrawal phenomena occur on anti-depressants?

A

Within 1-3 days of stopping or reducing doses

59
Q

How long does withdrawal phenomena occur when coming off antidepressants?

A

1-2 weeks

60
Q

What can rapidly suppress withdrawal from anti-depressants?

A

Re-introducing the drug

61
Q

Can withdrawal occur with missed doses of some antidepressants?

A

Yes

62
Q

A patient represents with:
-Dizziness, light-headedness
-Sleep disturbances
-Agitation, volatility
-Electric shocks in the head
-Nausea
-Fatigue
-Headache
-‘Flu-like’ symptoms

What drug are they likely having discontinuation symptoms from?

A

SSRI

63
Q

A patient represents with:
-Dizziness, light-headedness
-Sleep disturbances
-Agitation, volatility
-Electric shocks in the head
-Nausea
-Fatigue
-Headache
-‘Flu-like’ symptoms
-Restlessness
-Abdominal distension
-Congested sinuses

What drug are they likely having discontinuation symptoms from?

A

SNRIs - venlafaxine, duloxetine

64
Q

If a patient has been on long-term therapy with an antidepressant, how should you withdraw their treatment?

A

Reduce by 25% every 4-6 weeks

65
Q

If a patient has been on anti-depressants for 6-8 months, how should you withdraw their treatment?

A

Taper over 67-8 week period

66
Q

If a patient has been on a antidepressant for less than 8 weeks how should you withdraw treatment?

A

Stepwise over 1-2 weeks

67
Q

What antidepressants can cause anti-cholinergic side effects?

A

TCA, MAOI

68
Q

What antidepressants can cause sedation?

A

TCA, SNRI, Mirtazapine (NaSSA), Trazodone

69
Q

What antidepressants can cause a lowered BP?

A

TCA, SNRI, Trazodone, MAOI

70
Q

What antidepressants can cause nausea?

A

SSRI, TCA, SNRI, Trazodone

71
Q

What antidepressants can cause sexual dysfunction?

A

SSRI, TCA, SNRI, Trazodone, MAOI

72
Q

What antidepressants can cause weight gain

A

ALL

73
Q

What are some examples of anti-cholinergic side effects?

A

Blurred vision, constipation, dry mouth, urinary retention

74
Q

What are some examples of central side effects?

A

Anxiety, Seizures, confusion, dizziness, headaches, insomnia and sleep disturbances, nausea, sleepiness or sedation, suicidal idealtion

75
Q

What antidepressants have the lowered sexual dysfunction risk?

A

Mirtazapine and Agomelatine

76
Q

What antidepressants have little effect with alcohol?

A

SSRIs, Venlafaxine, Vortioxetine, Nortriptyline, Clomipramine

77
Q

What antidepressants when taken with alcohol can increase sedation?

A

Mirtazapine, Mianserin, Trazodone, Amitriptyline, Dozepin.

78
Q

What drug when taken alongside alcohol might lower the seizure threshold?

A

Tricyclics

79
Q

What is the issue with having NSAIDs and SSRIs together?

A

Double the risk of upper GI bleeds (reduced by having a PPI!)

80
Q

How does taking a SSRI with Warfarin affect the INR?

A

Significantly raises INR

81
Q

If a patient is taking paroxetine and tamoxifen what can this do?

A

Increase the risk of recurrence of breast cancer.

82
Q

What can decrease duloxetine levels?

A

Smoking

83
Q

How does smoking affect Clozapine?

A

Increases levels

84
Q

For children and teenagers what does NICE recommend?

A

1st line - Fluoxetine + psychological therapies
2nd line - Sertraline or Citalopram

85
Q

What age is fluoxetine licensed for?

A

8-17 if unresponsive to 4-6 sessions of psychological therapies

86
Q

What age is Sertraline licensed for OCD?

A

6-17

87
Q

Citalopram SmPC states it should not be used under what age?

A

18

88
Q

There are links between what antidepressant and autism?

A

SSRIs

89
Q

What antidepressant is best to be avoided in pregnancy?

A

Paroxetine

90
Q

What antidepressants are better tolerated than TCAS but increase the bleeding risk?

A

SSRIs

91
Q

What antidepressant group increases the risk of hyponatraemia, postural HTN, falls and haemorrhagic stroke?

A

SSRIs

92
Q

What antidepressant is recommended in Cardiac Disease?

A

SSRIs

93
Q

Can Mirtazapine be used in patients with Cardiac disease?

A

Yes

94
Q

What drug group can protect against MI’s?

A

SSRIs

95
Q

What antidepressant is the best drug choice post MI?

A

Sertraline

96
Q

What antidepressants can increase the QT interval?

A

SSRIs and TCA’s

97
Q

What drug is contraindicated in known prolonged QT?

A

Citalopram and Escitalopram

98
Q

If a patient has electrolyte disturbances and bradycardia can SSRI’s be used?

A

Used in CAUTION!!

99
Q

If patient has a renal impairment what adverse drug reactions are more likely?

A

Confusion, Postural HTN, sedation

100
Q

Can serum creatine levels be normal in elderly even if they have renal impairment?

A

Yes

101
Q

What can be an indication to metabolic impairment?

A

LFTs

102
Q

What type of drug needs care when prescribed in Hepatic impairment?

A

Those with high first-pass clearance

103
Q

In severe liver disease what should be avoided (antidepressants)

A

Those that cause marked sedation and/or constipation

104
Q

What antidepressant is used by some liver units and displays few issues?

A

Paroxetine

105
Q

What are the 4 theories of depression?

A

1) Monoamine theory 5HT
2) Inflammatory theory
3) HDA dysregulation
4) Structural changes in the brain

106
Q

What does this:
-Acts on SERT
-Pre-synaptic terminal
-MAO prevent reuptake of 5HT, increase synaptic levels of 5HT
-Works on receptor
-Selectivity

A

SSRI’s

107
Q

What does this:
-Acts on enzyme monoamine oxidase
-Inside the neuron drugs need to pass into
-MOA: binds to enzyme inhibits enzyme activity prevents degregation of 5HT and NA - consequence increased levels of 5HT-NA generally = MORE 5HT/NA released,
Have same outcome as SSRI but different MOA.

A

MAO Inhibitors

108
Q

What antidepressant block monoamine reuptake?

A

Tricyclic antidepressants

109
Q

What does fluoxetine act on?

A

SERT

110
Q

What does Lorazepam act on?

A

GABAa receptors

111
Q

What does Buspirone act on?

A

5HT1A receptors

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