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Psychiatric conditions > Depression > Flashcards

Depression Flashcards

1
Q

What neurotransmitters are believed to be involved in the cause of depression?

A 
*****Serotonin (5-HT) - most improtant  
Glutamate
Acetylcholine (ACh)
**Dopamine (DA)
**Norepinephrine (NE) 
Epinephrine (EPI)
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2
Q

What tools are used in diagnosing depression?

A

HDRS (aka Ham-D) score for medical office use

DSM-5

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3
Q

What are the criteria for depression diagnosis using DSM-5?

A

M SIG E CAP

Mood 
Sleep - increased or decreased 
Interest/pleasure - diminished
Guilt or feelings of worthlessness
Energy - decreased 
Concentration - decreased 
Appetite - increased/decreased 
Psychomotor agitation or retardation 
Suicidal ideation

*** Must exhibit at least 5 of the above mentioned symptoms

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4
Q

Why is it important to rule out bipolar disorder prior starting an antidepressant medication for the treatment if depression?

A

To avoid induced mania or causing rapid-cycling between bipolar depression and mania

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5
Q

True or False:
Benzodiazepines can be used as adjectively to the treatment of depression but never as mono-therapy to manage presentation of anxiety.

A

True

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6
Q

What drugs can cause or worsen depression

A 
Methylphenidate and other stimulants 
Methadone or chronic Opioid use 
Clonidine 
Methyldopa 
Procainamide 
Cyclosporine
Isotretinoin 
Beta Blockers (especially propranolol)
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7
Q

What are some natural products which can be used to treat depression?

A

St. John’s wort
SAMe (S-adenosyl-L-methionine)
Valerian

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8
Q

What is the first-line treatment for mild, moderate, and severe depression?

A

Mild: Psychotherapy or medication

Moderate/Severe: Medication with or without psychotherapy

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9
Q

What is the first-line drug treatment for depression?

A

SSRI or SNRI

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10
Q

When are MAOI used in the treatment of depression?

A

Only in patients unresponsive to other treatments

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11
Q

What is the protocol when discontinuing antidepressants drugs?

A

Must be tapered off over several weeks

except for Fluoxetine

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12
Q

What are some withdrawal symptoms seen with the discontinuation of antidepressant drugs?

A 
Anxiety 
Agitation
Insomnia
Dizziness
Flu-like symptoms
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13
Q

Which SSRI/SNRI are the biggest offender of withdrawal symptoms upon discontinuation?

A

Paroxetine

Venlafaxine

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14
Q

Which SSRI/SNRI does not need to be tapered off and why?

A

Fluoxetine

b/c it has a really long half-life

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15
Q

What is an adequate time to treat with an antidepressant before determining it doesn’t work?

When can we diagnose a patient is Treatment-Resistant depression?

A

6 to 8 weeks

Treatment-Resistant if on 2 meds and no change in symptoms

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16
Q

What atypical anti-psychotic drugs are approved to be used along with antidepressants in treatment resistant patients?

A

Aripiprazole
Olanzapine + Fluoxetine
Quetiapine ER

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17
Q

During pregnancy and breastfeeding, if it is determined that drug therapy for depression is needed, what drugs is recommended?

A

SSRI
with the exception of paroxetine

Tricyclics are also commonly used
with the exception of doxepin

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18
Q

Which SSRI CANNOT be used in pregnancy?

A

Paroxetine

due to increased risk of cardiac effects

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19
Q

What drug is approved for the treatment of postpartum depression?

A

Brexanolone (Zulresso)

IV infusion over 60 minutes

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20
Q

All antidepressant BBW

A

Can increase suicidal thought or actions in children, teenagers or young adults

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21
Q

What is the max dosing on Citalopram?

A

40mg/day

22
Q

What is the max dosing on Citalopram in the elderly ≥ 60 years old?

A

20mg/day

23
Q

What is the max dosing on Escitalopram in the elderly ≥ 60 years old?

A

10mg/day

24
Q

What is the max dosing on Escitalopram?

A

20mg/day

25
Q

Which SSRI is recommended in patients with cardiac risk?

A

Sertraline

26
Q

SSRI ADE

A 
Insomnia 
Nausea 
Dry moth 
Diaphoresis
Weakness
Tremor
Dizziness
Headache 
Decreased libido (b/c of 5-HT effects)
27
Q

SSRI/SNRI warning

A

QT prolongation (discontinue if QTc > 500 msec)
SIADH
Hyponatremia
Bleeding

28
Q

What indications, other than depression, is Venlafaxine used for?

A

GAD
Panic disorder
Social Anxiety Disorder

29
Q

What indications, other than depression, are SSRIs used for?

A

OCD

30
Q

What is the MDD of Venlafaxine IR and ER?

A

IR: 375 mg/day
ER: 225 mg/day

31
Q

SNRI ADE

A 
Increased HR
Increase BP
Dry mouth 
Excessive sweating and constipation 
Bleeding
32
Q

MOA of Tricyclics

A

Mainly inhibits NE and 5-HT re-uptake

Also block ACh and histamine receptors (this is what causes the ADE)

33
Q

Tricyclics agents

A

Tertiary amines

  • Amitriptyline (Elavil)
  • Doxepin (Solenor)

Secondary amine
- Nortriptyline (Palmelor)

34
Q

Tricyclics ADE

A 
Blurred visions 
Dry mouth 
Urination retention 
Constipation 
Weight gain
35
Q

Tricyclics warning

A

QTc prolongation (discontinue if QTc > 500 msec)

36
Q

Agents which inhibit re-uptake of Dopamine and Norepinephrine

A

Bupropion (Wellbutrin, Zyban)

37
Q

Bupropion contraindication

A

Contraindication in patients with seizure disorders, history of anorexia or bulimia

38
Q

If a patient has concern with antidepressants decreasing libido, which drug can be recommended?

A

Bupropion (Wellbutrin, Zyban)

Mirtazepine (Remeron)

39
Q

Bupropion ADE

A

Dry mouth
Insomnia
Tremors/seizures (dose related)
Weight loss

40
Q

What is the MDD of Bupropion and why?

A

450 mg/day

b/c of seizure risk

41
Q

Why aren’t Monoamine Oxidase Inhibitors rarely used?

A

B/c they have a high risk of:

  • Serotonin syndrome when combined with other meds
  • Drug-drug and food interaction which can be fatal if missed (e.g. tyramine-rich food)
  • Hypertensive crisis when combined with other meds
42
Q

To avoid Serotonin Syndrome what is the washout period when switching b/w MAOI and SSRI/SNRI/TCA/Bupropion?

A

5-week with Fluoxetine b/c the long half-life

2-weeks with all others

43
Q

Whats one major drug-drug interaction with MAOI

A

SSRI/SNRI/TCA/Bupropion (and tyramine-rich food)

Increased risk of Serotonin Syndrome

44
Q

What is the dose for Trazodone when being used for sedation?

A

50 - 100 mg QHS

45
Q

Trazodone ADE

A

Sedation (risk of falls in the elderly)

Priapism

46
Q

Mirtazapine ADE

A

Sedation (risk of falls in the elderly)
Increased appetite
Weight gain

47
Q

Other than depression, what else is Mirtazapine used for?

A

To increase appetite in malnutrition patients usually in the elderly

48
Q

Which antidepressant should be recommended for patients who would like to loss weight?

A

Bupropion

49
Q

Which antidepressant should be recommended for patients who have neuropathic pain?

A

Duloxetine

50
Q

Which antidepressant should be recommended for patients who have insomnia and depression?

A

Mirtazapine

51
Q

Antipsychotics BBW

A

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at high risk of Death

Psychiatric conditions (6 decks)

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