Depression Flashcards
How to treat mild depression
cognitive behaviour therapy
How to treat moderate to severe depression
Antidepressants
How long do you need to take Antidepressants for it to be deemed ineffective
4 weeks
(as the first 1 to 2 weeks symptoms might get worse)
How long do you need to take Antidepressants for it to be deemed ineffective for ELDERLY
6 weeks
How long after remission should you still be taking Antidepressants
6 months
(1 year in elderly and recurrent depression)
What is the 1st and 2nd Line treatment for Depression
1st Line:
SSRI
2nd Line:
- increase dose
- change SSRI
- TCA
- Venlafelaxine
- Mirtazapine
What is the 3rd and 4th Line treatment Line for Depression
3rd Line:
+ Lithium / Antipsychotics
4th Line:
Electrocompulsive Therapy
What is the 1st Line medication for Depression for a paitent who is =<17 years
Fluoxetine
If a patient is at risk of bleeding and needs to be treated for depression, what medication would you use
Mirtazapine
What is the most suitable medication for depression for patients who have cardiac events
Sertraline
(SSRIs)
Which SSRIs induce QT prolongation
Escitalopram nd Citalopram
Side Effects of SSRIs
- GI disturbances
- Weight gain
- Sexual dysfunction
- risk of bleeding
- Insomnia (take it in the morning)
Interactions of SSRIs
- CYP450 inducers and inhibitors
- drugs that cause QT prolongation
- drugs that increase risk of bleeding
- drugs that cause hyponatraemia
- drugs that cause serotonin syndrome
Which drugs cause serotonin syndrome
- SSRI
- TCA
- MAOaI
- Triptans
- Tramadol
- Lithium
What 3 types of side effects can serotonin syndrome cause
- Cognitive
- Autonomic
- Neuromuscular
What are cognitive side effects
- confusion
- coma
- headache
- agitation
What are Autonomic side effects
- sweating
- nausea
- hyperthermia
- Diarrhoea
What are Neuromuscular side effects
- termour
- teeth grinding
- myoclonus (sudden muscle contractions)
Examples of Sedating Tricyclic Antidepressants
- Amitriptyline
- Clomipramine
- Dosuleptin
- Trazodone
Examples of Less-Sedating Tricyclic Antidepressants
- Imipramine
- Lofepramine
- Nortriptaline
Which 2 Tricyclic Antidepressants are not recommended in Depression and why
- Amitriptyline
- Dosuleptin
because they are dangerous in overdose
Side effects of Tricyclic Antidepressants
- dry mouth, dehydration (anti-muscarinic)
- hypotension
- hallucinations
- cardiac events
Interaction of Tricyclic Antidepressants
- CYP450 inhibitors and Inducers
- drugs that cause QT prolongation
- anti-muscarinic drugs
- anti-hypertensive
- drugs that cause serotonin syndrome
Which foods should you avoid with Monoamine Oxidase-A Inhibitors
Tyramine rich foods
Which OTC product should you avoid with Monoamine Oxidase-A Inhibitors and why
- Pseudoephedrine
because MAOi cause hypertensive crisis
What toxicity do Monoamine Oxidase-A Inhibitors cause
Hepatotoxicity
Examples of Monoamine Oxidase-A Inhibitors
- Selegiline
- Isocarboxazid
- Phenelzine
- Tranylcypromine
Clomipramine(TCA) + Tranylcypromine(MAOi) Interaction
Fatal (AVOID)
How long should you wait between taking these medication:
Clomipramine/Imipramine(TCA)
+
Tranylcypromine(MAOi)
3 weeks
How long should you wait to start other Antidepressants after taking MAOi
2 weeks
How long should you wait to start taking MAOi after stopping other MAOi
2 weeks
How long should you wait to start taking MAOi after stopping TCAs
1 to 2 weeks
How long should you wait to start taking MAOi after stopping SSRIs
1 week
How long should you wait to start taking MAOi after stopping Fluoxetine
5 weeks
Why does there need to be a gap between different Antidepressants and MAOi
Because MAOi need a washout period
