Depression Flashcards
Depression Diagnosis (DSM-5 Criteria)
Mood - depressed
Sleep - increased/decreased
Interest/pleasure - diminished
Guilt or feelings of worthlessness
Energy - decreased
Concentration - decreased
Appetite - increased/decreased
Psychomotor agitation or retardation
Suicidal ideation
M SIG E CAPS
Drugs that can worsen depression
Atomoxetine
Indomethacin
Efavirenz
Rilpivirine
Beta-blockers (especially propranolol)
Hormonal contraceptives
Anabolic steroids
Antidepressants
Benzodiazepines
Systemic steroids
Interferons
Varenicline
Ethanol
Medical conditions that can contribute to depression
Stroke
Parkinson disease
Dementia
Multiple sclerosis
Hypothyroidism
Low vitamin D levels
Metabolic conditions (hypercalcemia)
Malignancy
Overactive bladder
Infectious diseases
MAO-I washout periods
2-week washout required between MAO-Is and:
SSRIs
SNRIs
TCAs
Bupropion
5-week washout is required when changing from:
Fluoxetine —> MAO-I (due to fluoxetine’s long half life)
Why do MAO-Is need a washout?
To avoid serotonin syndrome and hypertensive crisis
Best antidepressants for cardiac/QT risk
Sertraline preferred
Do not choose a QT-prolonging drug/dose (high doses of citalopram or escitalopram)
Watch for additive QT effects when SSRIs, SNRIs, TCAs, mirtazapine or trazodone are used with other QT-prolonging drugs
Best antidepressants for smokers
Bupropion SR is FDA-approved for smoking cessation
Best antidepressants for peripheral neuropathy or pain
Duloxetine
Medications to avoid on serotonergic antidepressants
Avoid multiple serotonergic medications due to risk of serotonin syndrome
Increased bleeding risk with anticoagulants, antiplatelets, NSAIDs, and some natural products (ginkgo, garlic, ginger, ginseng, glucosamine, fish oils)
Antidepressant medication to avoid with a seizure disorder or at risk for seizures (bulimia/anorexia, recent alcohol or sedative withdrawal)
Do not use bupropion
Best antidepressant to use when pregnant
Do not use paroxetine
Mild-to-moderate depression: psychotherapy is first-line
Certain SSRIs (escitalopram, sertraline) are first-line if using drug therapy
Best antidepressant for daytime sedation
Do not take a sedating drug early in the day (mirtazapine, paroxetine, trazodone)
Activating medications taken in the morning are preferred (fluoxetine, bupropion)
Best antidepressant for insomnia
Do not take an activating drug later in the day (bupropion, fluoxetine)
Sedating medications taken at night are preferred (paroxetine, mirtazapine, trazodone)
Best antidepressants for sexual dysfunction
High risk with SSRIs/SNRIs
