depression Flashcards
1
Q
when to suspect bipolar disorder
A
- multiple antidepressant tx failures
- nonresponse or erratic response to antidepressants
- suboptimal outcomes to antidepressants
2
Q
effect of SSRI/ SNRIs on bipolar
A
- NOT recommended firs tline
- increased mania
- mood instability
- erratic/ incomplete/ non-response to depressive sx
3
Q
SSRIs and suicide in geriatrics
A
- long term protection against suicide
4
Q
bereavement
A
- depressive sx that occur after loss of loved one
5
Q
adjustment disorder
A
- dev emotional and/or behavioral sx within 3 mo of identifiable life stressor
6
Q
major depressive episode
A
- 5 or more depressive sx for 2 weeks
7
Q
persistent depressive disorder
A
- “not as bad as MDD”
- depressed mood for more days than not
8
Q
general treatment guidelines for depression
A
- psychotherapy effective monotx for mild
- mod-severe depression best tx with psychotherapy + pharm tx
- all classes of pharm tx are equally efficacious
- generally SSRIs used fist
- SSRIs first line in geriatrics
9
Q
name the SSRI drugs
A
- fluoxetine
- paroxetine
- sertraline*- good first line choice
- fluvoxamine
- citalopram
- escitalopram*- good first line choice
10
Q
SSRI ADRs
A
- HA
- somnolence
- N/V/ D
- sexual dysfunction
- wt gain
- dev tolerance to all except sexual dysfunction
11
Q
less common ADRs with SSRIs
A
- QTc prolongation
- SIADH- elderly
- excessive bleeding- increase in PUD, caution only if already existing ulcer
12
Q
withdrawal of SSRIs
A
- dizziness
- ataxia
- flu like sx
- irritability
- NOT life treatening
- can last up to 14 d
- occurs within 1-20 d of cessation
13
Q
SSRI drug interactions
A
- fluoxetine and paroxetine are potent 2D6 inhibitors
14
Q
vilazodone
A
- brand: Viibryd
- partial 5HT1 agonist
- similar efficacy to SSRI but worse tolerability
- expensive!
- ADRs: HA, N/D, decreased libido
15
Q
vortioxetine
A
- brand: trintillix
- partial 5HT1a agonst, 7 antagonist
- similar efficacy and ADR profile to SSRIs
- expensive!
- ADRs: HA, N/D, dizziness, decreased libido
16
Q
trazodone
A
- has potent anti-histaminic effect
- not strong enough blockade for anti-depressant effect
- used mainly to promote sleep with comorbid depression
17
Q
name the SNRI drugs
A
- venlafaxine
- desvenlafaxine
- duloxetine
- levomilnacipram
18
Q
venlafaxine
A
- SNRI
- dose dep effect
- anything < 150 mg will act as SSRI
- use as XR
- ADRs: nausea, HA, insomina, BP increase
19
Q
desvenlafaxine
A
- SNRI
- similar CV risk as venlafaxine but more robust
- good for severe liver impairment
- don’t require high doses like venlafaxine
20
Q
duloextine
A
- SNRI
- possible hepatotoxicity- really only with concurrent chronic alcohol dependence
- can be used for neuropathy
- ADRs: HA, nausea, sexual dysfn, insomnia, urinary hestiancy, mild HR and BP increase
21
Q
levomilnacipran
A
- SNRI
- closer ration of 5HT to NE
- not as great for depression
- can consider for neuropathic pain + depression
22
Q
name the TCA drugs
A
- imipramine
- amitryptyline
- nortriptyline
- clomipramine
- desipramine
23
Q
MOA of TCAs
A
- similar to SNRIs
- 5HT
- NE
- anti-muscarinic
- anti-histaminic
- alpha 1 blockade
24
Q
ADRs of TCAs
A
- deadly in OD*
- seizures*
- arrhythmias*
- tachycardia*
- coma*
- constipation
- blurred vision
- dry mouth
- sedation
- HA
- sexual dysfunction
- cognitive impairment
- orthosis
- photosensitivity
- hyperglycemia
25
mirtazapine ADRs
- somnolence
- xerostomia
- increased appetitie
- hyperglycemia
- hyperTG
- hypercholesterolemia
- arganulocytosis
- anti-emetic
26
bupropion
- MOA: DA and NE
- lowers seizure threshold*
- promotes smoking cessation
- useful for drug induced sexual dysfunction
- INEFFECTIVE for anxiety, may worsen
27
bupropion ADRs
- agitation
- insomnia
- irritability
- dry mouth
- nausea
- tachycardia
28
serotonin syndrome causes
- combo of SSRI, SNRI, TCA, MAOIs
- st john's wort
- tramadol
- meperidine
- tryptophan
- isoniazide
29
si/sx of serotonin syndrome
- tremor*
- akathisia*
- hypomania
- confusion
- hyperreflexia*
- myoclonus*
- diaphoresis
- yperthermia
- can cause death via anoxia, aspiration, multiple organ failure
30
tx for serotonin syndrome
- cyproheptadine
31
tx of depression in pregnancy/ lactation
- best if no med
- fluoxetine best studies
- paroxetine is worst in pregnancy
- sertraline and paroxetine have negligible levels with breast feeding
32
follow up visits after starting antidepressats
- 10-14 d mark to assess tolerability, safety, SI
- 4 week mark to assess efficacy
- 6-8 week mark to measure max response
- every mo for 4-9 mo during continuation phase
33
assessing response of antidepressants
- if at 4-8 weeks of tx and only partial response increase dose
- if at 4-8 weeks of tx and no response switch med
- after 2 trials pt is "tx resistant"
- usu SSRI -> SSRI -> SNRI
34
treatment refractory options
- switch to third monotx
- add second antidepressant from dif class
- can augment with Li, T3, atypical antipsychotics
35
common antidepressant combos
- SSRI + bupropion
- SNRI + mirtazapine
- bupropion: stim effect
- mirtazapine: hypnotic effect
- can do SSRI + antipyschotic but less effective, onset of 2 weeks, risk of mvmt disorders
36
antipsychotics that can be used as adjunct antidepressant
- apriprazole
- olanzapine
- quetiapine
37
tx for OCD in peds
- clopiramine
- fluvoxamine
- sertraline
38
tx for GAD in peds
- duloxetine
39
tx for enuresis in peds
- imipramine
40
DOC for depression in peds
- fuloxetine
| - then escitalopram
41
tx algorithm for depression in peds
- placebo/ supportive care just as effective in kids < 12 as drugs
- supportive care + pharm tx for best outcomes
- monitor carefully for SI after initiating pharm tx for 3 mo
- tx for at least a year
42
suicide risk in peds
- youths 2X more likely to have SI
- BBW on antidepressants for suicidality
- acutal data suggests that states with hight anti-depressant rates have few suicides
- CAN prescribe antidepressants to peds but must monitor closely
43
ADRs for SSRIs in peds
- insomnia
- somnolence
- jitteriness
- GI pain
- flu like sx
- suicide risk
