Depression Flashcards
What are the Kubler Ross stages of grief?
DABDA Denial Anger Bargaining Depression Acceptance **can happen with loss or imminent loss or any major life event
What are the risk factors for suicide?
DIT:
Psych disorder
Feelings of hopelessness or worthlessness
Impulsivity
increased age (younger-attempt more, older-successful more)
Male sex (women attempt more, men succeed more)
Access to weapons (firearms)
Hx of suicide attempt
SADPERSONS: Sex (male) Age (young & old) Depression Previous Attempt EtoH or drug use Rational thinking gone Sickness Organized Plan No spouse Social support lacking
What is required for diagnosis of Major Depressive Disorder?
5/9 SIGECAPS for >2 wks, must include anhedonia or depressed mood
What is persistent depressive disorder (dysthymia)?
depression (sometimes milder)>2 years
What is atypical depression?
mood reactivity (happier when good things happen) interpersonal rejection sensitivity leaden paralysis hypersomnia hyperphagia 1. CBT & SSRIs 2. MAO inhibitors
What are the features of sleep in MDD?
Increased REM decreased REM latency Increased REM early in sleep cycle less slow wave sleep **repeated nighttime awakenings and early morning awakening
What are the SSRIs?
Flashbacks paralyze senior citizens fluoxetine paroxetine sertraline citalopram
What are the SE of SSRIs?
sexual dysfunction
risk for serotonin syndrome
SIADH, GI distress
What are the SNRIs? What is their MOA?
Venlafaxine duloxetine desvenlafaxine minacipran inhibit 5-HT and NE reuptake
What else is venlafaxine used for?
generalized anxiety disorder
panic disorder
PTSD
What else is duloxetine used for?
diabetic peripheral neuropathy, chronic pain
What is minacipran used for?
not depression
fibromyalgia
What are the TCAs? What is their MOA?
**inhibit 5-HT and NE reuptake amitriptyline nortriptyline imipramine desipramine clomipramine doxepin amoxapine
What is a special function of imipramine ?
helps w/ bed wetting
What else is clomipramine used for?
OCD, like trichotillomania
What are the SE of TCAs?
Tri-Cs
anti-Cholinergic: tachycardia, urinary retention, dry mouth, confusion, hallucination
Cardiotoxicity: prolong QT interval, arrhythmias
CNS toxicity: seizures, coma
What is the treatment for OD on TCAs?
NaHCO3
What are some MAOIS?
MAO Takes Pride In Shanghai Tranylcypromine Phenelzine Isocarboxazid Selegiline Rasagiline
What else are selegiline and rasagiline used for? MOA?
specifically inhibit MAO-B which break down dopamine
used to treat Parkinson’s
What is the SE of MAOIs?
HTN crisis w/ ingestion of tyramine (in old cheese etc)
Serotonin Syndrome
What does tyramine do exactly at nerve terminals?
stimulates release of NE along with amphetamines and ephedrine
What are some drugs that when taken together could cause serotonin syndrome?
SSRIs SNRIs TCAs MAOIs Triptans (migraines) St. John's Wart Kava-kava amphetamines
What is the MOA of bupropion?
we don’t know, but increases NE and dopamine
What are the side effects of bupropion?
stimulation-insomnia
seizures, esp if anorexic or bulimic
NO SEXUAL SIDE EFFECTS
What is another indication for bupropion?
smoking cessation
What is the MOA of mirtazapine?
alpha 2 antagonist
weirdly 5-HT2 and 5-HT3 antagonist
What are the side effects of mirtazapine?
sedation and dry mouth
increase in appetite and weight gain
great for skinny insomniacs who are elderly
What is the MOA for trazadone and nefazadone?
inhibits 5-HT2 and alpha 1
What is the main indication for trazadone and main SE?
used for insomnia (not really for depression)
main side effect is priapism.
What are the symptoms of serotonin syndrome?
muscle rigidity
cardiovascular collapse (autonomic instability)
hyperpyrexia
