Depression and Treatment Flashcards
what aspect of depression do these sx address: depresed mood, anhedonia, decreased interest, irritability, guilt/worthlessness, suicidal ideation
psychological
what aspect of depression do these sx address: appetite, sleep, energy, concentration
neurovegative
What does SIGECAPS stand for?
sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicidal
Frequency of depressive symptoms that qualifies it as a disorder
symptoms occur in the same two weeks, most of the day and nearly everyday
Risk factors include: family h/o, childhood onset of depression, no response or agitation to antidepressants
bipolar disorder
sx include: euphoria, irritability, grandiosity, increased energy, decreased sleep, risk taking, more talkative
bipolar disorder
Type of bipolar characterized by mania that lasts one week and marked impairment
bipolar disorder I
Type of bipolar characterized by hypomania that lasts 4 days and there is a change that is observable by others
bipolar disorder II
Psychotic features
delusions, hallucinations, disordered thought
What do the following conditions have in common: sleep apnea, hypothyroidism, chronic pain, stroke, heart disease
medical conditions that can cause depression
Name some common medication classes that can cause depression
beta-blockers, corticosteroids, benzodiazepine, Varenicline (Chantix)
Comorbid psychiatric conditions with depression
anxiety disorders and substance abuse
What does DIGFAST stand for?
distractible, impulsive, grandiose, flight of ideas, activities, sleep, talkative
What does CAGE stand for?
felt need to Cut down on drinking, annoyed by ppl criticizing your drinking, felt Guilty about your drinking, ever had an Eye opener
Hamilton anxiety score that indicates significant anxiety
> 20
Name the SSRIs
Fluvoxamine (Luvox), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac)
First line treatment of depressive disorders. No real differences in efficacy. Difference in side effects and half lives
SSRIs
Side effects include: GI disturbance, sexual dsyfxn, anxiety, insomnia/sedation, sweating, dizziness
SSRIs
Acts on both serotonin and norepinephrine. Not clearly more efficacious
SNRIs
Name the two SNRIs
Venlafaxine (Effexor). Duloxetine (Cymbalta)
Indicated for neuropathy
Duloxetine (Cymbalta)
Side effects of SNRIs
HTN and tachycardia
Name the TCAs
Amitriptyline, Nortriptyline, Clomipramine, Doxepin, Imipramine
Side effects include: Anticholinergic, Antihistamine, Orthostatic hypotension, Cardiac
TCAs
Why are TCAs not frequently used?
lethal in overdose and more drug-drug interactions
Name the two MAOIs
phenelzine (Nardil), tranylcypromine (Parnate)
Good for sleep at low doses. If tolerated – functions as an AD at higher doses. Watch for sedation, orthostasis, priapism
Trazodone
Uses include: Major Depressive disorder: ADHD: Smoking cessation
Bupropion
CI to Bupropion
seizure disorders and bulimia
Antidepressant that is safe in pregnancy and can be added on to SSRI to restore libido
Bupropion
Used off-label for insomnia
and as appetite stimulant. Good for patients with nausea
Mirtazapine
How long does it take at a minimum for medication to be effective?
2-4 weeks
What should you do if there is no improvement in patient in 4-6 weeks?
consider switch, increase dose or augmentation
Most expensive antidepressant
Duloxetine
Population with increased risk of suicide with antidepressants
up to 24yrs old
Longer acting benzos with lower abuse potential. Short term use
clonazepam, lorazepam over alprazolam, diazepam
