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Depression guidelines Flashcards

1
Q

First-line psychotherapy acute treatment MDE

A
  • CBT
  • IPT
  • BA (behavioral activation
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2
Q

Second-line psychotherapy acute treatment MDE

A
  • MBCT
  • CBASP (cognitive-behavioural analysis system of psychotherapy)
  • PST (problem-solving therapy)
  • STPP (Short-term psychodynamic psychotherapy)
  • Telephone-delivered CBT and IPT
  • Internet- and computer-assisted therapy
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3
Q

Third-line psychotherapy acute MDE

A
  • Long-term psychodynamic psychotherapy (PDT)
  • Acceptance and commitment therapy (ACT)
  • Videoconferenced psychotherapy
  • Motivational interviewing (MI)
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4
Q

First-line psychotherapy maintenance (relapse-prevention) MDD

A
  • CBT
  • MBCT
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5
Q

Second-line psychotherapy maintenance (relapse-prevention) MDD

A
  • IPT
  • BA
  • CBASP
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6
Q

Third-line psychotherapy maintenance (relapse-prevention) MDD

A
  • Long-term psychodynamic psychotherapy
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7
Q

AGOMELATINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • MT1 and MT2 agonist; 5-HT2 antagonist
  • 25-50 mg
  • first-line
  • Valdoxan
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8
Q

BUPROPION

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • NDRI
  • 150-300 mg
  • First-line
  • Wellbutrin
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9
Q

CITALOPRAM

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SSRI
  • 20-40 mg
  • First-line
  • Celexa, Cipramil
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10
Q

DESVENLAFAXINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SNRI
  • 50-100 mg
  • First-line
  • Pristiq
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11
Q

DULOXETINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SNRI
  • 60 mg
  • First-line
  • Cymbalta
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12
Q

ESCITALOPRAM

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SSRI
  • 10-20 mg
  • First-line
  • Cipralex, Lexapro
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13
Q

FLUOXETINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SSRI
  • 20-60 mg
  • First-line
  • Prozac
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14
Q

FLUVOXAMINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SSRI
  • 100-300 mg
  • First-line
  • Luvox
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15
Q

MIANSERIN

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • α2-adrenergic agonist; 5-HT2 antagonist
  • 60-120 mg
  • First-line
  • Tolvon
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16
Q

MILNACIPRAN

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SNRI (N > S)
  • 100 mg
  • First-line
  • Ixel
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17
Q

MIRTAZAPINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • α2-adrenergic agonist; 5-HT2 antagonist
  • 15-45 mg
  • First-line
  • Remeron
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18
Q

PAROXETINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SSRI
  • 20-50 mg ; 25-62.5 for CR version
  • First-line
  • Paxil
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19
Q

SERTRALINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SSRI
  • 50-200 mg
  • First-line
  • Zoloft
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20
Q

VENLAFAXINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SNRI
  • 75-225 mg
  • First-line
  • Effexor
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21
Q

VORTIOXETINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • Serotonin reuptake inhibitor
  • 5-HT1A agonist
  • 5-HT1B partial agonist
  • 5-HT1D , 3A and 7 antagonist
  • 10-20 mg
  • First-line
  • Brintellix, Trintellix
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22
Q

TRICYCLICS

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • TCA
  • Various
  • Second-line
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23
Q

LEVOMILNACIPRAN

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • SNRI (N>R)
  • 40-120 mg
  • Second-line
  • Fetzima
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24
Q

MOCLOBEMIDE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • Reversible inhibitor of MAO-A
  • 300-600 mg
  • Second-line
  • Manerix
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25
QUETIAPINE * Mechanism of action * Dose range * Line of treatment * Commercial name
* Atypical antipsychotic * 150-300 mg * Second-line * Seroquel
26
SELEGILINE TRANSDERMAL * Mechanism of action * Dose range * Line of treatment * Commercial name
* Irreversible MAO-B inhibitor * 6-12 mg daily transdermal * Second-line * Emsam
27
TRAZODONE * Mechanism of action * Dose range * Line of treatment * Commercial name
* Serotonin reuptake inhibitor (less potently) * 5-HT2Aantagonist (potently - Stahl) * 150-300 mg * Second-line * Desyrel
28
VILAZODONE * Mechanism of action * Dose range * Line of treatment * Commercial name
* Serotonin reuptake inhibitor * 5-HT1A partial agonist * 20-40 mg (titrate from 10 mg) * Second-line * Viibryd
29
PHENELZINE * Mechanism of action * Dose range * Line of treatment * Commercial name
* Irreversible MAO inhibitor * 45-90 mg * Third-line * Nardil
30
TRANYLCYPROMINE * Mechanism of action * Dose range * Line of treatment * Commercial name
* Irreversible MAO inhibitor * 20-60 mg * Third-line * Parnate
31
REBOXETINE * Mechanism of action * Dose range * Line of treatment * Commercial name
* NRI * 8-10 mg * Third-line * Edronax
32
Algorithm for selecting an antidepressant
33
Recommendations with anxious distress
* Use antidepressant with efficacy in GAD (level 4) (No differences in efficacy between SSRIs, SNRIs, and buproprion (level 2))
34
Recommendations with catatonic features
* Benzodiazepines (level 3) * No antidepressants have been studied
35
Recommendations with melancholic features
* No specific antidepressants have demonstrated superiority (level 2) * TCA and SNRI have been studied
36
Recommendations with atypical features
* No specific antidepressants have demonstrated superiority (level 2) * Older studies have found MAO inhibitors superior to TCAs
37
Recommendations with psychotic features
* Use antipsychotic and antidepressant cotreatment (level 1) * Few studies involved atypical antipsychotics
38
Recommendations with mixed features
* Lurasidone (level 2) * Ziprasidone (level 3) * No comparative studies
39
Recommendations with seasonal pattern
* No specific antidepressants have demonstrated superiority (level 2 and 3) * SSRIs, agomelatine, bupropion and moclobemide have been studied
40
Recommendations with cognitive dysfunction
* Vortioxetine (level 1) * Buproprion (level 2) * Duloxetine (level 2) * SSRI (level 2) * Moclobemide (level 3) * Limited data available on cognitive effects of other antidepressants and on comparative differences in efficacy
41
Recommendations with sleep disturbances
* Agomelatine (level 1) * Mirtazapine (level 2) * Quetiapine (level 2) * Trazodone (level 2) * Beneficial effects on sleep must be balanced against potential for side effects (e.g. daytime sedation)
42
Recommendations with somatic symptoms
* Duloxetine (pain) (level 1) * Other SNRI (pain) (level 2) * Bupropion (fatigue) (Level 1) * SSRI (fatigue) (level 2) * Duloxetime (energy) (level 2) * Few comparative antidepressant studies for pain or other somatic symptoms
43
Antidepressant with Evidence of Superior Efficacy (based on Meta-Analyses)
* Escitalopram (level 1) * Mirtazapine (level 1) * Sertraline (level 1) * Venlafaxine (level 1) * Agomelatine (level 2) * Citalopram (level 2)
44
Agomelatine levels increased by CYP X inhibition
* CYP 1A2
45
Clozapine levels increased by CYP X inhibition
* CYP 1A2
46
Duloxetine levels increased by CYP X inhibition
* CYP 1A2
47
Caffeine levels increased by CYP X inhibition
* CYP 1A2
48
Naproxen levels increased by CYP X inhibition
* CYP 1A2
49
Olanzapine levels increased by CYP X inhibition
CYP 1A2 & 2D6
50
Risperidone levels increased by CYP X inhibition
CYP1A2 & 2D6
51
Theophylline levels increased by CYP X inhibition
CYP 1A2
52
Warfarin levels increased by CYP X inhibition
* CYP 1A2 * CYP 2C19
53
Antiepileptics (diazepam, phenytoin, phenobarbital) levels increased by CYP X inhibition
CYP 2C19
54
Propranolol levels increased by CYP X inhibition
CYP 2C19 & 2D6
55
Tricyclic antidepressant levels increased by CYP X inhibition
CYP 2D6
56
Beta-blockers (metoprolol, propanolol) levels increased by CYP X
2D6
57
Codeine and other opioids' effects reduced by CYP X
2D6
58
Vortioxetine levels increased by inhibition of CYP X
2D6
59
Tamoxifen's effect is reduced by CYP X inhibition
2D6
60
Tramadol levels increased by CYP X inhibition
2D6
61
Amiodarone levels increased by CYP X inhibition
3A4
62
Calcium channel antagonists levels increased by CYP X inhibition
3A4
63
Haloperidol levels increased by CYP X inhibition
3A4
64
HIV protease inhibitors increased by CYP X inhibition
3A4
65
Statins levels increased by CYP X inhibition
3A4
66
Immune modulators (cyclosporine, tacrolimus) levels increased by CYP X inhibition
3A4
67
Levomilnacipran levels increased by CYP X inhibition
3A4
68
Macrolide antibacterials (clarithromycin, erythromycin) levels increased by CYP X inhibition
3A4
69
Methadone levels increased by CYP X inhibition
3A4
70
Phenothiazines levels increased by CYP X inhibition
3A4
71
Quetiapine levels increased by CYP X inhibition
3A4
72
Sildenafil levels increased by CYP X inhibition
3A4
73
Tamoxifen levels increased by CYP X inhibition
3A4
74
Vilazodone levels increased by CYP X inhibition
3A4
75
Potential for interaction of Citalopram
Minimal or low
76
Potential for interaction of Desvenlafaxine
Minimal to low
77
Potential for interaction of Escitalopram
Minimal to low
78
Potential for interaction of Mirtazapine
Minimal or low
79
Potential for interaction of Venlafaxine
Minimal or low
80
Potential for interaction of Paliperidone
Minimal or low
81
Potential for interaction of Agomelatine
Moderate (1A2 substrate)
82
Potential for interaction of Bupropion
Moderate: 2D6 inhibitor
83
Potential for interaction of Duloxetine
Moderate: 2D6 inhibitor, 1A2 substrate
84
Potential for interaction Levomilnacipran
Moderate (3A4 substrate)
85
Potential for interaction of Sertraline
Moderate (2D6 inhibitor)
86
Potential for interaction of Vilazodone
Moderate via 3A4 substrate
87
Potential for interaction of Vortioxetine
Moderate via 2D6 inh
88
Potential for interaction of Aripiprazole
Moderate via 2D6 and 3A4 substrate
89
Potential for interaction for Olanzapine
Moderate via 1A2 substrate
90
Potential for interaction for Risperidone
Moderate via 2D6 and 3A4 substrate
91
Potential for interaction of Fluoxetine
Higher via (2D6, 2C19 substrate)
92
Potential for interaction of Fluvoxamine
Higher via 1A2, 2C19, 3A4 inh
93
Potential for interaction of Moclobemide
Higher: MAO inhibitor precautions
94
Potential for interaction of Paroxetine
Higher via 2D6 inh
95
Potential for interaction of Selegiline
Higher via MAO inhibitor precautions
96
Potential for interaction of Clozapine
Higher via 1A2 and 3A4 substrate
97
Potential for interaction of Lurasidone
Higher via 3A4 substrate
98
Potential for interaction of Quetiapine
Higher via 3A4 substrate
99
Risk factors to consider for longer-term (2 years or longer) maintenance treatment with antidepressants (level 3 and 4 evidence)
* Frequent, recurrent episodes * Severe episodes (psychosis, severe impairement, suicidality) * Chronic episodes * Presence of comorbid psychiatric or other medical conditions * Presence of residual symptoms * Difficult-to-treat episodes
100
How long to maintain treatment after symptom remission if NO risk factors for recurrence?
6-9 months
101
First-line adjunctive treatment for depression (with doses)
* Aripiprazole (2-15 mg) * Quetiapine (150-300 mg) * Risperidone (1-3 mg)
102
Second-line adjunctive treatment for depression (with doses)
* *Brexpiprazole (1-3 mg)* * *Olanzapine (2.5-10 mg)* * _Mirtazapine / mianserin (30-60 mg)_ * _Bupropion (150-300 mg)_ * Lithium (600-1200 mg - therapeutic serum levels) * Modafinil (100-400 mg) * Triiodothyronine (25-50 mcg)
103
Third-line adjunctive treatments for depression
* Other antidepressants * Other stimulants (methylphenidate, lisdexamfetamine) * TCA (e.g. desipramine) * Ziprasidone
104
First-line neurostimulation for acute MDE
* rTMS (for patients who failed at least 1 antidepressant) * ECT in some clinical situations
105
Second-line neurostimulation treatment for acute MDE
* ECT
106
LEVEL 1 neurostimulation treatments for maintenance of MDD
* ECT
107
LEVEL 2 neurostimulation treatments for maintenance of MDD
* VNS
108
First-line recommendations for rTMS stimulation protocols
* High-frequency rTMS to left DLPFC * Low-frequency rTMS to right DLPFC
109
Level 1 clinical indication for ECT as first-line
* Acute suicidal ideation * Psychotic features * Treatment-resistant depression
110
First-line recommendation for delivery of ECT
* BP RUL (brief pulse right unilateral) (at 5-6 times seizure threshold) * BP BF (bifrontal) at 1.5-2.0 times seizure threshold
111
Recommendation for maintenance pharmacotherapy post-ECT
Use either * An antidepressant that has not been tried prior to ECT * Nortriptyline + Lithium * Venlafaxine + Lithium
112
First-line physical and meditative CAMs for MDE (monotherapy and adjunctive)
* Exercise for mild to moderate MDD in monotherapy * Light therapy in monotherapy for seasonal (winter) MDD
113
Second-line physical and meditative CAMs for MDE (monotherapy and adjunctive)
* Exercise as adjunctive therapy for moderate to severe MDD * Light-therapy as monotherapy and adjunctive for mild to moderate nonseasonal MDD * Yoga as adjunctive for mild to moderate MDD
114
First-line natural health products (monotherapy and adjunctive)
* St. John's wort for mild to moderate MDD as monotherapy
115
Second-line natural health products (monotherapy and adjunctive)
* St. John's wort as adjunctive for moderate to severe MDD * Omega-3 as monotherapy or adjunctive to mild to moderate MDD + adjunctive to moderate to severe MDD * SAM-e as adjunctive for mild to moderate MDD + adjunctive for moderate to severe MDD
116
First-line for MDD in Children / Youth
* CBT * IPT * Internet-based psychotherapy (for milder severity, if in-person is not possible)
117
Second-line for MDD in Children / Youth
* Fluoxetine * Escitalopram * Citalopram * Sertraline
118
Third-line for MDD in Children / Youth
* Venlafaxine & TCA (only for \> 12 yo)
119
First-line if minimal or nonresponse in MDD in Children/Youth
* Add SSRI to psychotherapy
120
Second-line if minimal or nonresponse in MDD in Children/Youth
* Switch for another SSRI (if unresponsive to fluoxetine)
121
Third-line if minimal or nonresponse in MDD in Children/Youth
* Venlafaxine & TCA (for \> 12 yo)
122
First-line for TRD in Children / Youth
* SSRI + psychotherapy
123
Second-line for TRD in Children / Youth
* Switch to another SSRI (if unresponsive to SSRI)
124
Third-line for TRD in Children / Youth
* Venlafaxine * TCA * Neurostimulation treatment (ECT or rTMS) All if \> 12 yo
125
First-line for mild to moderate MDD during pregnancy
* CBT (individual or group) * IPT (individual or group)
126
Second-line for mild to moderate MDD during pregnancy
* Citalopram * Sertraline * Escitalopram
127
First-line for mild to moderate postpartum depression during breastfeeding
* CBT * IPT
128
Second-line treatment for mild to moderate postpartum depression during breastfeeding
* Citalopram * Escitalopram * Sertraline * Combination SSRI + CBT + IPT
129
First-line for perimenopausal MDD
* Desvenlafaxine * CBT
130
Second-line treatment for perimenopausal MDD
* Transdermal estradiol * Citalopram * Escitalopram * Duloxetine * Venlafaxine XR * Mirtazapine * Quetiapine XR
131
First-line treatment for late-life depression
* Duloxetine, Mirtazapine, Nortriptyline (level 1) * Desvenlafaxine * Venlafaxine * Citalopram * Escitalopram * Bupropion * Sertraline * Vortioxetine
132
Second-line treatment for late-life depression
A) Switch to * Nortriptyline * Moclobemide * Phenelzine * Quetiapine * Trazodone * Bupropion B) Combine with * Aripiprazole * Lithium * Methylphenidate
133
What are antidepressant discontinuation symptoms?
FINISH 1) Flu-like symptoms 2) Insomnia 3) Nausea 4) Imbalance 5) Sensory disturbances 6) Hyperarousal
134
What is the standard protocol for light therapy and when is the expected response?
The standard protocol is: - 10,000 lux (light intensity) for 30 minutes per day during the early morning for up to 6 weeks - With response usually seen within 1 to 3 weeks.
135
What are the criteria for persistent depressive disorder?
Humeur dépressive plus d'un jour sur deux, au moins 2 ans (1 an pour enfants / ados), pas plus de 2 mois sans symptômes avec 2 critères ou plus: * F atigue ou baisse d'énergie * A ppétit (diminué ou hyperplasie) * S ommeil (insomnie ou hypersomnie) * P erte d'espoir * E stime de soi faible * T rouble de concentration ou ambivalence
136
What is the age criteria for early-onset PDD?
* before 21
137
What are the three different types of persistent depressive disorder?
138
* What is the age criteria for DMDD?
139
What is the most recommended contraceptive for PMDD?
* Yasmin / YAZ (drospirenone-containing OCP)
140

Nik essentials guidelines (6 decks)

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