Depression Flashcards
Symptoms of depression: “SIGECAPS”
Sleep changes Interest loss Guilt Energy loss Concentration loss Appetite changes Psychomotor agitation Suicidal
Diagnosis of depression requires:
5 symptoms of SIGECAPS in a 2 week period. One symptom must be either depressed mood or loss of interest/pleasure
Medications that can worsen depression
Hormones and heart medications
Treatment phases and goals
Acute phase: 6-12 weeks; goal of remission
Continuation phase: 4-9 months; goal to eliminate symptoms and prevent relapse
Maintenance phase: 12-36 months; goal to prevent recurrence
How to discontinue antidepressants
Taper, do not stop abruptly; this may cause recurring symptoms
Highest risk of relapse is within ___ months of discontinuation
2
Time to effects of antidepressants
Week 1: energy, sleep, appetite
Week 2: sadness, libido, self-care, concentration, suicide risk
Week 4: depressed mood, hopelessness, interest
Takes 4-6 weeks to see a response from the medication
Nonresponse: ___% decrease in baseline symptoms
Partial response: ___% decrease in baseline symptoms
Partial remission: ___% decrease in baseline symptoms
<25%
25-49%
>50%
First line treatment options
SSRI, SNRI, bupropion, mirtazapine
Second line treatment options
Switch to a different first line option or augment with an antidepressant with a different MOA
Third line treatment options
Consider TCA or MAO-I
6 different SSRIs
Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft)
The maximum recommended dose for citalopram is ___mg or ___mg for people age 60+
40mg
20mg
___ is the SSRI which is the most activation and has the least sexual dysfunction
Fluoxetine
___ is the SSRI with the longest half-life and is best for non-adherent patients
Fluoxetine
The washout period for all SSRIs is ___ weeks besides fluoxetine, which has a washout period of ___ weeks
2
5
___ is the SSRI which is pregnancy category D and has a high rate of sexual side effects
Paroxetine
___ is the SSRI which causes GI side effects and has a high rate of sexual side effects
Sertraline
4 different SNRIs
Duloxetine (Cymbalta)
Desvenlafaxine (Pristiq)
Venlafaxine (Effexor)
Levomilnacipran (Fetzima)
The initial dose of venlafaxine is ___mg/day and the usual dose is ___mg/day
37.5-75mg/day
75-225mg/day
This SSRI can cause QT prolongation
Citalopram
This SNRI is associated with CV adverse effects
Venlafaxine
This SNRI is associated with an increased risk of hyperlipidemia
Dexvenlafaxine
This SNRI is contraindicated with hepatic impairment
Duloxetine
True or False: SNRIs cause greater sexual dysfunction than SSRIs
False. SNRIs cause little sexual dysfunction
The primary symptom of serotonin syndrome is ___
Myoclonus (muscle rigidity)
How to treat serotonin syndrome
- Discontinue med
- Hydration and antipyretics (Tylenol, ibuprofen)
- Serotonin antagonist in more severe cases (cyproheptadine)
Symptoms of discontinuation syndrome (abrupt stopping of SSRI or SNRI)
Flu-like symptoms
This SSRI is least likely to cause discontinuation syndrome
Fluoxetine due to its long half-life
This antidepressant is useful for co-management of depression and smoking cessation/patients with ADHD with the added benefit of causing no sexual dysfunction
Bupropion
Avoid this antidepressant in patients with eating disorders, alcohol use, and seizures
Bupropion
Bupropion IR dosing
100mg BID. Max of 450mg daily (divided TID)
Max of 150mg/dose
Bupropion XR dosing
150-450mg QD
Adverse effects of bupropion include:
Weight gain, increased lipids, and drowsiness
A rare (usually during first month of treatment) adverse effect of this antidepressant is priapism
Trazodone
True or False: The antidepressant effect of trazodone is only seen at higher doses
True. Also, its side-effects limit its use as an antidepressant
TCAs commonly have ___ side effects
Anticholinergic (dry)
___ can lower seizure threshold and have a risk of overdose in suicide
TCAs
Examples of TCAs
Tertiary amines - Greater inhibition of serotonin reuptake > NE Amitriptyline Clomipramine Doxepin Imipramine
Secondary amines
- Greater inhibition of NE > serotonin; less anticholinergic side effects
Desipramine
Nortriptyline
Examples of MAO-Is
Phenelzine
Tranylcypromine
Selegiline
This MAO-I comes as a patch
Selegiline
Avoid taking MAO-Is with food that contain ___
Tyramine (beer, cheese, dry meat, fava beans)
Can cause hypertensive crisis (increase BP, diaphoresis, NV, HA)
First line therapy should be tried for at least ___ weeks before switching to an alternative therapy
4
Antidepressants should be continued for at least ___ year
1
All antidepressants have a BBW for ___ in people aged ___
Suicidal thoughts
18-24
In elderly patients, initiate antidepressants at ___ the normal dose and titrate more ___
1/2
Slowly
