Depression Flashcards
Depression is the reduction which neurotransmitters where???- 3
A reduction of serotonin,dopamine,norephedrine athe the synaptic cleft
Scale treatment for mild,moderate- for moderate what may patients feel and for how long??? How long should it still be taken for ( what about elderly) - before it is deemed ineffective??? How long do we take it after remission( elderly/if recurrent)
Mild: cognitive behavioural therapy
Moderate-severe:antidepressants
In the 1st one to two weeks patients may feel worse in the first 2 weeks
- Should be taken for 4 weeks (6 weeks in elderly) before its deemed ineffective
- Take for 6 months after remission(after that discussion),elderly 1 year, 2 years if recurrent
Treatment of Depression… What is first line??what would you use for patients 17 and under?? If that doesn’t work what can we try??
First line: SSRI:
- Doesn’t work increase dose
- Change SSRI
- Mirtazapine
- TCA or venlafaxine(severe)
- Rare - MAO -I
17 and less - use fluoxetine
If that doesn’t work add another class, lithium or antipsychotics
- Use electroconvulsive therapy in severe refractory depression
Mirtazapine is best use in patients with….
best in patients with bleeding disorders and bleeding risks
SSRIs are better tolerated and safer in what? Consider first line in treating what? Which SSRI is the safest with cardio events? Which is used for under 17? What are SSRI better and safer than???
Better tolerated and safer in overdose
Considered first- line for treating depression
- Sertraline safest in patients with cardiac events
- In children under 17 Fluoxetine
SSRIs better and safer than tricyclic anti depressants
SSri side effects - what time would we. Take them??? Whitchurch ones cause QT prolongation??
Side effects:
GI disturbances(Diarrhoea and vomiting)
Appetite/weight gain
Sexual dysfunction
Risk of bleed
Insomnia(take medication in the morning)
QT prolongation(Escitalopram and citalopram)
SSri interaction
Interactions:
CYP enzyme inhibitors(avoid grapefruit,increases plasma concentration)
CYP enzyme inducers(reduce effectiveness)(st johns wart)
Drugs that cause QT prolongation(Amioderone,Soto lol,quinolones)
Drugs increasing risk of bleeding
Hyponatraemia(carbamazepine and diuretics)
Serotonin syndrome
Serotonin syndrome:
Triad of side effects -
Cognitive:headaches,agitation,hypomania,coma,confusion
Autonomic:Sweating,hyperthermia,nausea,diarrhoea
Neuromuscular excitation: Myoclonus,tremor,teeth grinding
- Caused by: - SSRIs,TCA,MAO-I - Tramadol - Lithium ABX-LENEZALID?
Tricyclic Antidepressants: what are the seating ones better at doing? And list some examples…. What are the less sedating ones good at doing?? List some examples
What are the two at risk of a high overdose and not recommended in the treatment of amitriptyline?
Tricyclic Antidepressants:
- Sedating- better for agitated and anxious patients
Amitriptyline.clomipramine,dosulepin,trazadone
-less sedating:
Imipramine,lofepramine and nortriptyline
Amitriptyline and Dosulepin:Dangerous in overdose- not recommended of depression treatment - Hugh risk of over dose
Side effects- tca - Remeber CASHHHHH
Cardiac events
Anti muscarinic (dry mouth,constipation)
Seizure threshold reduced
Hypotension - associated with TCA overdose
Hallucinations
CASHH
Tca interaction - Inhibitors and inducers do what??? Remember how it works??
Interactions:
- CYP enzymes inhibitors (avid grapefruit,increases plasma concentration)
- CYP enzyme inducers(reduces effectiveness)
- Drug that cause QT prolongation( Aioderone,Soto lol,quinolones)
- Anti-muscarinic drugs
- Anti-hypertensive drugs
- Serotonin syndrome
MAO inhibitors:specaialist use only - what kind of toxicity can they cause?? - which ones?What otc medication can cause a hypertensive crisis, avoid what kind of food???? What is a fatal TCA and MOAI combo
- Cause hepatoxicity (phenelzine and iscocarboxazid)
- Hypertensive crisis - do not give otc pseudophedrine
- Avoid tyramine rich food
- Tranylcypromine and clomipramine = fatal
MAO I washout period:
Anti depressants should not be started within how many weeks after treatment with moai? And two exceptions are …..
Don’t start MOAI until
MAO I washout period:
- Anti depressants should not be started for 2 weeks after treatment with MAOI (3 weeks for clomipramine or imipramine)
Don’t start MAOI until
- 2 weeks after a previous MAOI has been stopped (0 weeks for moclobemide)
- 1-2 weeks after a tricyclic or related anti depressant has been stopped (3 weeks for clomipramine or imipramine)
- 1 week after an SSRI or related anti depressant has been stopped(5 weeks for fluoxetine)
