Depression Flashcards
What drugs cause or worsen depression?
What is the depression diagnosis?
What natural products work in depression?
ADHD meds, Analgesics(Indomethacin, Methadone), Antiretrovirals (Efavirenz, Rilpivirine). Cardiovascular (Beta-blockers, especially propranolol, clonidine, methyldopa, procainamide, reserpine), Hormones (hormonal contraceptives, anabolic steroids), Other(antidepressants, systemic steroids, cyclosporine, isotretinoin, interferons, varenicline, ethanol). Stroke, parkinsons, dementia, MS, hypothyroidism, low vitamin d levels, metabolic conditions, malignancy, OAB and infectious diseases.
M SIG ECAPS.
St. John’s wort or SAMe may be helpful.
What are your MAO inhibitors?
What drugs are improved for augmentation therapy?
What SSRI is CI’d in pregnancy?
Phenelzine (Nardil), tranylcypromine (parnate), and isocarboxazid (Marplan) is restricted to resistant. BBW of suicidal thinking, watch for drug-drug and drug-food interactions, if missed could be fatal. Change emsam patch once daily.
Buspirone, abilify, olanzapine + fluoxetine, quetiapine extended release, sometimes lithium.
Paroxetine and Brisdelle especially is CI’d.
What are the SSRI’s?
What are the SSRI side effects?
What is the SSRI and 5-HT1A partial agonist and what to know?
Fluoxetine (prozac, sarafem), Paroxetine(paxil), sertraline (zoloft), citalopram (celexa), escitalopram (lexapro). Symbyax is QHS, PMDD is Sarafem.
Antidepressants increase the risk of suicidal thinking and behaviour in children, adolescents, and young adults. Concurrent use with MAOIs and linezolid, pregnancy brisdelle. QT prolongation (citalopram is 40 mg/day, do not exceed 20 mg/day in elderly (>60), SIADH, hyponatremia, bleeding. Sexual side effects, somnolence, insomnia, nausea, dry mouth, diaphoresis(dose related), weakness, tremor, dizziness, headache (but may help for migraines if taken continuously). Fluoxetine can cause activation.
Vilazodone (Viibryd), take with food, suicidal thoughts, no MAOI, less sexual SE’s.
What is the SSRI, 5-HT receptor antagonist, and 5-HT1A agonist?
What’s your washout periods?
What SSRIs have the most QT prolongation?
Nausea.
2 week between MAOI and fluoxetine needs a 5 week washout period.
Citalopram and Escitalopram. Additive risk.
What increases bleeding risk on SSRIs?
What are the SSRI drug interactions?
What are the SNRI’s?
Anticoagulants, antiplatelets, NSAIDs
CYP2D6 2C19 inhibitor is Fluoxetine. Paroxetine is CYP2D6 inhibitor. Tamoxifen requires CYP2D6 and therefore fluoxetine,paroxetine, and sertraline, and duloxetine and bupropion.
Venlafaxine (Effexor, Effexor XR), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq). Venlafaxine has a max dose of 375 mg/ day for IR.
What else can Duloxetine be used for?
What are the side effects of SNRIs?
What SNRI has additive prolongation risk?
Peripheral neuropathy, fibromyalgia.
Suicidal risk, SNRI and MAOIs, increased hr dilated pupils, dry mouth, excessive sweating and constipation, increased BP all have risk but especially at higher doses. Some sexual difficulties for some patients but not all.
Venlafaxine.
What are the Tertiary amines and what to know?
What is a secondary amines?
What is your dopamine and norepinephrine reuptake inhibitor?
Amitriptyline, Doxepin (silenor is for insomnia), QHS amitriptyline. BBW of suicidal thinking, MAOI, QT prolongation with overdose (suicidal ideation as overdose can quickly cause fatal arrhythmias, orthostasis).
Nortriptyline. Dry mouth, blurred vision, urinary retention, constipation, tertiary amines have increased anticholinergic properties.
Bupropion (wellbutrin SR, Wellbutrin XL). + Naltrexone is contrave for weight management. Zyban for smoking cessation. Do not exceed 450 mg/day due to seizure risk.
What are you bupropion drug interactions?
What to know about mirtazapine?
What to know about Trazodone?
Suicidal thinking, seizure disorder, history of anorexia/bulimia, abrupt discontinuation of ethanol or sedatives, dry mouth, insomnia, tremors/seizures (dose-related), weight loss, sexual dysfunction is rare.
Remeron, Remeron SolTab. BBW of suicidal thinking, help with sleep and increase appetite. Sedation, increased appetite and weight gain.
Used for sleep, QHS, BBW of suicidal thinking, sedation, priapism.
What to know about Nefazodone?
What to know about Aripiprazole?
What to know about Quetiapine?
Hepatotoxicity, BBW of suicidal thinking and hepatotoxicity.
Abilify, BBW of suicidal thinking, Symbyax should not be used with QT prolonging drugs including pimozide, thioridazine. Anxiety, insomnia, constipation, agitation.
Seroquel, Seroquel XR. Sedation, Orthostasis, weight gain, increased lipids, glucose, EPS(lower risk).
