Depression

Question 1

what is the depression scale most widely used

Answer 1

HDRS or Ham-D

Question 2

What is the DSM-5 of depression

Answer 2

at least five of these
Mood-depressed
Sleep-increased/decreased
Interest/pleasure-diminished
Guilt or feeling of worthlessness
Energy-Decreased
Concentration-Decreased
Appetite-increased or decreased
Psychomotor agitation or retardation
Suicidal ideation
"M SIG E CAPS"

Question 3

Use of BZD in depression

Answer 3

used when anxiety is also present

do not use alone will mask depression

Question 4

Drugs that worsen depression

Answer 4

ADHD medications
indomethacin
Antiretrovirals
Beta-blockers
hormones

Question 5

list MAOI

Answer 5

phenelzine
tranylcypromine
isocarboxyazid

Question 6

which drug doesn’t need to be tapered off since it self-tapers due to a long half-life

Answer 6

fluoxetine

Question 7

how long to trial an antidepressant before concluding it doesn’t work

Answer 7

6-8 weeks

Question 8

preferred antidepressants to use in pregnancy

Answer 8

SSRIs

-no paroxetine-cardiac effects

Question 9

preferred antidepressant to use in post-partum depression

Answer 9

SSRIs
Tricyclics
-not doxepin

Question 10

Which symptoms improve first with antidepressants

Answer 10

physical symptoms take a few weeks

psychological symptoms take a month or more

Question 11

List SSRIs (5)

Answer 11

citalopram
escitalopram
fluoxetine
paroxetine
sertraline

Question 12

Major warnings for SSRIs

Answer 12

QT prolongation
SIADH
hyponatremia
bleeding

Question 13

SE of SSRIs

Answer 13

sexual side effects: decreased libido

Question 14

What is the most activating SSRI “energy”

Answer 14

fluoxetine

Question 15

What is the most sedating SSRI “tired”

Answer 15

paroxetine

Question 16

what SSRI is preferred in patients with cardiac risk

Answer 16

sertraline

Question 17

list SNRIs (3)

Answer 17

venlafaxine
duloxetine
desvenlafaxine

Question 18

What is the max dose of citalopram to prevent QT prlongation

Answer 18

40mg

Question 19

Tricyclics MOA

Answer 19

inhibit NE and 5HT reuptake also block ACh and histamine receptors
Secondary amines: more selective for NE
Tertiary amines: more effective and worse SE

Question 20

List tertiary amines (TCAs)

Answer 20

amitriptyline
doxepine
clomipramine
imipramine

Question 21

SE of TCAs

Answer 21

QT prolongation
orthostasis
Anticholinergic SE
weight gain

Question 22

List Secondary amines (TCAs)

Answer 22

nortriptyline

desipramine

Question 23

List DNRIs

Answer 23

buproprion

Question 24

Contraindication for buproprion

Answer 24

seizure disorder

history of bulemia/anorexia

Question 25

MOA of MAOis

Answer 25

inhibit the enzyme monoamine oxidase which breaks down catecholamines including 5-HT, NE, EPI, and DA if these NTs increase dramactically hypertensive crisis and death can result

Question 26

What foods to avoid in MAOIs

Answer 26

tyamine-rich - aged cheese - pickled herring - yeast extract - air-dried meat - sauerkraut - soy sauce

Question 27

How to avoid hypertensive crisis and serotonin syndrome

Answer 27

``` 2 week wash-out period b/w MAOI and -SSRI -SNRI -TCAs -Bupropion 5-week washout when changing from -fluoxetine to MAOI ```

Question 28

What anti-depressant to use to avoid weight gain

Answer 28

bupropion | -avoid mirtazepine

Question 29

What anti-depressants to use and not use with cardiac issues

Answer 29

use: sertraline avoid: citalopram, escitalopram

Question 30

What anti-depressant to use for depression with pain

Answer 30

duloxetine

Question 31

Treatment options for treatment resistant depression

Answer 31

aripiprazole quetiapine olanzapine/fluoxetine

Question 32

ability SE

Answer 32

anxiety insomnia akasthisia

Question 33

SE of olanzapine

Answer 33

sedation weight gain increase lipids increase glucose