Depression Flashcards
what is the depression scale most widely used
HDRS or Ham-D
What is the DSM-5 of depression
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"
Use of BZD in depression
used when anxiety is also present
do not use alone will mask depression
Drugs that worsen depression
ADHD medications indomethacin Antiretrovirals Beta-blockers hormones
list MAOI
phenelzine
tranylcypromine
isocarboxyazid
which drug doesn’t need to be tapered off since it self-tapers due to a long half-life
fluoxetine
how long to trial an antidepressant before concluding it doesn’t work
6-8 weeks
preferred antidepressants to use in pregnancy
SSRIs
-no paroxetine-cardiac effects
preferred antidepressant to use in post-partum depression
SSRIs
Tricyclics
-not doxepin
Which symptoms improve first with antidepressants
physical symptoms take a few weeks
psychological symptoms take a month or more
List SSRIs (5)
citalopram escitalopram fluoxetine paroxetine sertraline
Major warnings for SSRIs
QT prolongation
SIADH
hyponatremia
bleeding
SE of SSRIs
sexual side effects: decreased libido
What is the most activating SSRI “energy”
fluoxetine
What is the most sedating SSRI “tired”
paroxetine
what SSRI is preferred in patients with cardiac risk
sertraline
list SNRIs (3)
venlafaxine
duloxetine
desvenlafaxine
What is the max dose of citalopram to prevent QT prlongation
40mg
Tricyclics MOA
inhibit NE and 5HT reuptake also block ACh and histamine receptors
Secondary amines: more selective for NE
Tertiary amines: more effective and worse SE
List tertiary amines (TCAs)
amitriptyline
doxepine
clomipramine
imipramine
SE of TCAs
QT prolongation
orthostasis
Anticholinergic SE
weight gain
List Secondary amines (TCAs)
nortriptyline
desipramine
List DNRIs
buproprion
Contraindication for buproprion
seizure disorder
history of bulemia/anorexia
MOA of MAOis
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
What foods to avoid in MAOIs
tyamine-rich
- aged cheese
- pickled herring
- yeast extract
- air-dried meat
- sauerkraut
- soy sauce
How to avoid hypertensive crisis and serotonin syndrome
2 week wash-out period b/w MAOI and -SSRI -SNRI -TCAs -Bupropion 5-week washout when changing from -fluoxetine to MAOI
What anti-depressant to use to avoid weight gain
bupropion
-avoid mirtazepine
What anti-depressants to use and not use with cardiac issues
use: sertraline
avoid: citalopram, escitalopram
What anti-depressant to use for depression with pain
duloxetine
Treatment options for treatment resistant depression
aripiprazole
quetiapine
olanzapine/fluoxetine
ability SE
anxiety
insomnia
akasthisia
SE of olanzapine
sedation
weight gain
increase lipids
increase glucose
