Depression Flashcards
Though the pathophysiology of depression is not fully understood, which neurotransmitters have been implicated?
serotonin, dopamine, norepinephrine, glutamate, acetylcholine, epinephrine
Which assessment tool is the most frequently used for depression?
Ham-D aka HDRS
Of the symptoms listed in SIG E CAPS, ____ must be present in a ____ week period for a diagnosis of MDD.
5 in a 2 week period
An important potential comorbidity that must be screened for in depressive patients is ________.
bipolar disorder (antidepressants can exacerbate mania or cause rapid cycling of mood)
Which drugs/drug classes can cause or worsen depression?
ADHD drugs (atomoxetine) indomethacin antiretrovirals (mostly efavirenz) beta-blockers hormones antidepressants (lol) BZDs steroids varenicline
What medical conditions can contribute to depression or its development?
stroke, hypothyroidism, Parkinson dx, dementia, MS, low vitamin D, malignancy
Which two OTC supplements may have some efficacy in treating depression?
St. John’s Wort and valerian
St. John’s Wort is a potent CYP _______.
inducer
Since response to antidepressants is highly variable between patients, initial choice of therapy is based on what 3 things?
side-effect profile, safety concerns, and patient-specific symptoms
Which class of drugs used to treat depression is reserved for patients who have failed other treatments due to drug-drug and drug-food interactions?
MAO inhibitors
What are 5 options for patients experiencing a suboptimal response to therapy?
1) dose increase of current drug
2) combination of multiple antidepressants with different mechanisms of action
3) adding buspirone or low dose atypical antipsychotic
4) lithium or thyroid hormone augmentation
5) ECT
What is the general approach to treating depression in pregnancy?
Mild depression may not require medical treatment - use psychotherapy first and see if medication is necessary. More severe cases will likely require treatment through the pregnancy due to risk of poor maternal and fetal outcomes if left untreated. However, all drugs carry fetal risk. SSRIs are generally preferred, but have a few pearls. Paroxetine is contraindicated due to cardiac effects, and SSRIs as a class carry a risk of persistent pulmonary hypertension of the newborn.
Postpartum depression is most frequently treated with which two drug classes? Which medication is not used per ACOG guidelines?
SSRIs or tricyclic antidepressants most commonly used, doxepin not recommended
All antidepressants carry a boxed warning for what adverse outcome?
increase in suicidality
Between physical and psychological symptoms, which is usually the first to improve after starting pharmacotherapy for depression?
physical - psychological may take over a month to improve with daily medication use
What is the maximum daily dose of citalopram?
depends on age - 40 mg if less than 60, 20 mg if older
Match the medication(s) with the antidepressant(s) it is contraindicated with:
A- thioridazine 1. sertraline sol.
B- alosetron or tizanidine 2. all
C- disulfiram 3. fluox/parox
D- linezolid, pimozide 4. fluvox
A/3
B/4
C/1
D/2
The dose of escitalopram in the elderly should not exceed ____.
10 mg
What is the max daily dose of fluoxetine?
80 mg
What is the max daily dose of fluvoxamine?
300 mg/day - divide BID if TDD is to be > 100 mg
What is the max daily dose of sertraline?
200 mg
What two SSRIs can be used for PMDD?
fluoxetine and sertraline
What are the class side effects of SSRIs?
dry mouth, decreased libido, nausea, somnolence or insomnia, diarrhea, tremor, dizziness
Which SSRI is should be taken in the morning due to its activating property?
fluoxetine
