Depression

Question 1

DSM5 criteria

Answer 1

Requires at least 5 during a 2wk period
M SIG E CAPS
-mood
-sleep
-interest/pleasure
-guilt/worthlessness
-energy
-concentration
-appetite
-psychomotor agitation/retardation
-suicidal ideation
MUST INCLUDE EITHER MOOD OR INTEREST

Question 2

Neurotransmitters involved in depression

Answer 2

Serotonin
Glutamate 
Acetylcholine 
Dopamine
Norepinephrine 
Epinephrine

Question 3

Drugs that cause/worsen depression

Answer 3

Atomoxetine
Indomethacin
Efavirenz (Atripla)
BBs (propranolol)
OCPs
Varenicline 
Cyclosporine
Clonidine
Isotretinion

Question 4

Antidepressants in breastfeeding

Answer 4

SSRIs

Tricyclics

Question 5

Preferred SSRI if cardiac risk

Answer 5

Sertraline

Question 6

Most sedative SSRI

Answer 6

Paroxetine

Question 7

Most activating SSRI

Answer 7

Fluoxetine

Question 8

SSRI and 5-HT1A partial agonist

Answer 8

Vilazodone (Viibryd)

-take with food

Question 9

SSRI and 5-HT1A agonist and 5HT receptor antagonist

Answer 9

Vortioxetine (Trintellix)

Question 10

SNRIs

Answer 10

Venlafaxine
Duloxetine
Desvenlafaxine (Pristiq)
Levoomilnacipram (Fetzima)

Question 11

MOA of tricyclics

Answer 11

Inhibit NE and serotonin reuptake, plus block acetylcholine and histamine receptors

Question 12

Secondary amines

Answer 12

Nortiptyline

Desipramine

Question 13

Tertiary amines

Answer 13

More effective, but worse SEs (more anticholinergic, weight gain, sedation)
Amitriptyline
Doxepin
Clomipramine 
Imipramine

Question 14

Bupropion MOA

Answer 14

Dopamine and NE reuptake inhibitor

-no effect on serotonin

Question 15

CI for bupropion

Answer 15

Seizures

Anorexia/bulimia

Question 16

SE for bupropion

Answer 16

Dry mouth
Insomnia
Weight loss
CNS stimulant

Question 17

MAOIs

Answer 17

Isocarboxazid
Phenelzine
Tranylcypromine

Question 18

MAOIs MOA

Answer 18

Monoamine oxidase breaks down catecholamines; 5HT, NE, DA, EPI

If these NTs increase dramatically = HTN crisis

Question 19

MAOIs counselling points

Answer 19

SE: anticholinergic, orthostasis, sedation, sexual dysfunction, weight gain
Must avoid tyramine-rich foods: aged, fermented, pickled, smoked

Question 20

Meds that require 2 wk washout period with MAOIs

Answer 20

SSRIs (5wk for fluoxetine)
SNRIs
TCAs
Bupropion

Question 21

Depression meds if trying to avoid sexual dysfunction

Answer 21

Bupropion

Mirtazipine

Question 22

MOA of mirtazapine

Answer 22

Tetracyclic antidepressant

-increases 5HT and NE

Question 23

SE of mirtazapine

Answer 23

Weight gain
Sedation
Increased appetite
Anticholinergic

Question 24

Serotonin syndrome SE

Answer 24

HA
N
D
Dizziness
Increased heart rate
Hallucinations

Question 25

Only antipsychotic approved for treatment resistant depression

Answer 25

Olanzapine + Fluoxetine (Symbian)