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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?

22
Q

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

23
Q

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

24
Q

What is the max dosing on Escitalopram?

25
Which SSRI is recommended in patients with cardiac risk?
Sertraline
26
SSRI ADE
``` Insomnia Nausea Dry moth Diaphoresis Weakness Tremor Dizziness Headache Decreased libido (b/c of 5-HT effects) ```
27
SSRI/SNRI warning
QT prolongation (discontinue if QTc > 500 msec) SIADH Hyponatremia Bleeding
28
What indications, other than depression, is Venlafaxine used for?
GAD Panic disorder Social Anxiety Disorder
29
What indications, other than depression, are SSRIs used for?
OCD
30
What is the MDD of Venlafaxine IR and ER?
IR: 375 mg/day ER: 225 mg/day
31
SNRI ADE
``` Increased HR Increase BP Dry mouth Excessive sweating and constipation Bleeding ```
32
MOA of Tricyclics
Mainly inhibits NE and 5-HT re-uptake Also block ACh and histamine receptors (this is what causes the ADE)
33
Tricyclics agents
Tertiary amines - Amitriptyline (Elavil) - Doxepin (Solenor) Secondary amine - Nortriptyline (Palmelor)
34
Tricyclics ADE
``` Blurred visions Dry mouth Urination retention Constipation Weight gain ```
35
Tricyclics warning
QTc prolongation (discontinue if QTc > 500 msec)
36
Agents which inhibit re-uptake of Dopamine and Norepinephrine
Bupropion (Wellbutrin, Zyban)
37
Bupropion contraindication
Contraindication in patients with seizure disorders, history of anorexia or bulimia
38
If a patient has concern with antidepressants decreasing libido, which drug can be recommended?
Bupropion (Wellbutrin, Zyban) | Mirtazepine (Remeron)
39
Bupropion ADE
Dry mouth Insomnia Tremors/seizures (dose related) Weight loss
40
What is the MDD of Bupropion and why?
450 mg/day | b/c of seizure risk
41
Why aren't Monoamine Oxidase Inhibitors rarely used?
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
To avoid Serotonin Syndrome what is the washout period when switching b/w MAOI and SSRI/SNRI/TCA/Bupropion?
5-week with Fluoxetine b/c the long half-life 2-weeks with all others
43
Whats one major drug-drug interaction with MAOI
SSRI/SNRI/TCA/Bupropion (and tyramine-rich food) Increased risk of Serotonin Syndrome
44
What is the dose for Trazodone when being used for sedation?
50 - 100 mg QHS
45
Trazodone ADE
Sedation (risk of falls in the elderly) | Priapism
46
Mirtazapine ADE
Sedation (risk of falls in the elderly) Increased appetite Weight gain
47
Other than depression, what else is Mirtazapine used for?
To increase appetite in malnutrition patients usually in the elderly
48
Which antidepressant should be recommended for patients who would like to loss weight?
Bupropion
49
Which antidepressant should be recommended for patients who have neuropathic pain?
Duloxetine
50
Which antidepressant should be recommended for patients who have insomnia and depression?
Mirtazapine
51
Antipsychotics BBW
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at high risk of Death

Psychiatric conditions (6 decks)

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