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Nik essentials guidelines > Depression guidelines > Flashcards

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
Q

QUETIAPINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • Atypical antipsychotic
  • 150-300 mg
  • Second-line
  • Seroquel
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26
Q

SELEGILINE TRANSDERMAL

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • Irreversible MAO-B inhibitor
  • 6-12 mg daily transdermal
  • Second-line
  • Emsam
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27
Q

TRAZODONE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • Serotonin reuptake inhibitor (less potently)
  • 5-HT2Aantagonist (potently - Stahl)
  • 150-300 mg
  • Second-line
  • Desyrel
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28
Q

VILAZODONE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • Serotonin reuptake inhibitor
  • 5-HT1A partial agonist
  • 20-40 mg (titrate from 10 mg)
  • Second-line
  • Viibryd
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29
Q

PHENELZINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • Irreversible MAO inhibitor
  • 45-90 mg
  • Third-line
  • Nardil
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30
Q

TRANYLCYPROMINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • Irreversible MAO inhibitor
  • 20-60 mg
  • Third-line
  • Parnate
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31
Q

REBOXETINE

  • Mechanism of action
  • Dose range
  • Line of treatment
  • Commercial name
A
  • NRI
  • 8-10 mg
  • Third-line
  • Edronax
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32
Q

Algorithm for selecting an antidepressant

A
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33
Q

Recommendations with anxious distress

A
  • Use antidepressant with efficacy in GAD (level 4)
    (No differences in efficacy between SSRIs, SNRIs, and buproprion (level 2))
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34
Q

Recommendations with catatonic features

A
  • Benzodiazepines (level 3)
  • No antidepressants have been studied
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35
Q

Recommendations with melancholic features

A
  • No specific antidepressants have demonstrated superiority (level 2)
  • TCA and SNRI have been studied
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36
Q

Recommendations with atypical features

A
  • No specific antidepressants have demonstrated superiority (level 2)
  • Older studies have found MAO inhibitors superior to TCAs
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37
Q

Recommendations with psychotic features

A
  • Use antipsychotic and antidepressant cotreatment (level 1)
  • Few studies involved atypical antipsychotics
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38
Q

Recommendations with mixed features

A
  • Lurasidone (level 2)
  • Ziprasidone (level 3)
  • No comparative studies
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39
Q

Recommendations with seasonal pattern

A
  • No specific antidepressants have demonstrated superiority (level 2 and 3)
  • SSRIs, agomelatine, bupropion and moclobemide have been studied
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40
Q

Recommendations with cognitive dysfunction

A
  • 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
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41
Q

Recommendations with sleep disturbances

A
  • 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)
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42
Q

Recommendations with somatic symptoms

A
  • 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
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43
Q

Antidepressant with Evidence of Superior Efficacy

(based on Meta-Analyses)

A
  • Escitalopram (level 1)
  • Mirtazapine (level 1)
  • Sertraline (level 1)
  • Venlafaxine (level 1)
  • Agomelatine (level 2)
  • Citalopram (level 2)
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44
Q

Agomelatine levels increased by CYP X inhibition

A
  • CYP 1A2
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45
Q

Clozapine levels increased by CYP X inhibition

A
  • CYP 1A2
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46
Q

Duloxetine levels increased by CYP X inhibition

A
  • CYP 1A2
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47
Q

Caffeine levels increased by CYP X inhibition

A
  • CYP 1A2
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48
Q

Naproxen levels increased by CYP X inhibition

A
  • CYP 1A2
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49
Q

Olanzapine levels increased by CYP X inhibition

A

CYP 1A2 & 2D6

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50
Q

Risperidone levels increased by CYP X inhibition

A

CYP1A2 & 2D6

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51
Q

Theophylline levels increased by CYP X inhibition

A

CYP 1A2

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52
Q

Warfarin levels increased by CYP X inhibition

A
  • CYP 1A2
  • CYP 2C19
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53
Q

Antiepileptics (diazepam, phenytoin, phenobarbital) levels increased by CYP X inhibition

A

CYP 2C19

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54
Q

Propranolol levels increased by CYP X inhibition

A

CYP 2C19 & 2D6

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55
Q

Tricyclic antidepressant levels increased by CYP X inhibition

A

CYP 2D6

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56
Q

Beta-blockers (metoprolol, propanolol) levels increased by CYP X

A

2D6

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57
Q

Codeine and other opioids’ effects reduced by CYP X

A

2D6

58
Q

Vortioxetine levels increased by inhibition of CYP X

A

2D6

59
Q

Tamoxifen’s effect is reduced by CYP X inhibition

A

2D6

60
Q

Tramadol levels increased by CYP X inhibition

A

2D6

61
Q

Amiodarone levels increased by CYP X inhibition

A

3A4

62
Q

Calcium channel antagonists levels increased by CYP X inhibition

A

3A4

63
Q

Haloperidol levels increased by CYP X inhibition

A

3A4

64
Q

HIV protease inhibitors increased by CYP X inhibition

A

3A4

65
Q

Statins levels increased by CYP X inhibition

A

3A4

66
Q

Immune modulators (cyclosporine, tacrolimus) levels increased by CYP X inhibition

A

3A4

67
Q

Levomilnacipran levels increased by CYP X inhibition

A

3A4

68
Q

Macrolide antibacterials (clarithromycin, erythromycin) levels increased by CYP X inhibition

A

3A4

69
Q

Methadone levels increased by CYP X inhibition

A

3A4

70
Q

Phenothiazines levels increased by CYP X inhibition

A

3A4

71
Q

Quetiapine levels increased by CYP X inhibition

A

3A4

72
Q

Sildenafil levels increased by CYP X inhibition

A

3A4

73
Q

Tamoxifen levels increased by CYP X inhibition

A

3A4

74
Q

Vilazodone levels increased by CYP X inhibition

A

3A4

75
Q

Potential for interaction of Citalopram

A

Minimal or low

76
Q

Potential for interaction of Desvenlafaxine

A

Minimal to low

77
Q

Potential for interaction of Escitalopram

A

Minimal to low

78
Q

Potential for interaction of Mirtazapine

A

Minimal or low

79
Q

Potential for interaction of Venlafaxine

A

Minimal or low

80
Q

Potential for interaction of Paliperidone

A

Minimal or low

81
Q

Potential for interaction of Agomelatine

A

Moderate (1A2 substrate)

82
Q

Potential for interaction of Bupropion

A

Moderate: 2D6 inhibitor

83
Q

Potential for interaction of Duloxetine

A

Moderate: 2D6 inhibitor, 1A2 substrate

84
Q

Potential for interaction Levomilnacipran

A

Moderate (3A4 substrate)

85
Q

Potential for interaction of Sertraline

A

Moderate (2D6 inhibitor)

86
Q

Potential for interaction of Vilazodone

A

Moderate via 3A4 substrate

87
Q

Potential for interaction of Vortioxetine

A

Moderate via 2D6 inh

88
Q

Potential for interaction of Aripiprazole

A

Moderate via 2D6 and 3A4 substrate

89
Q

Potential for interaction for Olanzapine

A

Moderate via 1A2 substrate

90
Q

Potential for interaction for Risperidone

A

Moderate via 2D6 and 3A4 substrate

91
Q

Potential for interaction of Fluoxetine

A

Higher via (2D6, 2C19 substrate)

92
Q

Potential for interaction of Fluvoxamine

A

Higher via 1A2, 2C19, 3A4 inh

93
Q

Potential for interaction of Moclobemide

A

Higher: MAO inhibitor precautions

94
Q

Potential for interaction of Paroxetine

A

Higher via 2D6 inh

95
Q

Potential for interaction of Selegiline

A

Higher via MAO inhibitor precautions

96
Q

Potential for interaction of Clozapine

A

Higher via 1A2 and 3A4 substrate

97
Q

Potential for interaction of Lurasidone

A

Higher via 3A4 substrate

98
Q

Potential for interaction of Quetiapine

A

Higher via 3A4 substrate

99
Q

Risk factors to consider for longer-term (2 years or longer) maintenance treatment with antidepressants (level 3 and 4 evidence)

A
  • 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
Q

How long to maintain treatment after symptom remission if NO risk factors for recurrence?

A

6-9 months

101
Q

First-line adjunctive treatment for depression (with doses)

A
  • Aripiprazole (2-15 mg)
  • Quetiapine (150-300 mg)
  • Risperidone (1-3 mg)
102
Q

Second-line adjunctive treatment for depression (with doses)

A
  • 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
Q

Third-line adjunctive treatments for depression

A
  • Other antidepressants
  • Other stimulants (methylphenidate, lisdexamfetamine)
  • TCA (e.g. desipramine)
  • Ziprasidone
104
Q

First-line neurostimulation for acute MDE

A
  • rTMS (for patients who failed at least 1 antidepressant)
  • ECT in some clinical situations
105
Q

Second-line neurostimulation treatment for acute MDE

A
  • ECT
106
Q

LEVEL 1 neurostimulation treatments for maintenance of MDD

A
  • ECT
107
Q

LEVEL 2 neurostimulation treatments for maintenance of MDD

A
  • VNS
108
Q

First-line recommendations for rTMS stimulation protocols

A
  • High-frequency rTMS to left DLPFC
  • Low-frequency rTMS to right DLPFC
109
Q

Level 1 clinical indication for ECT as first-line

A
  • Acute suicidal ideation
  • Psychotic features
  • Treatment-resistant depression
110
Q

First-line recommendation for delivery of ECT

A
  • BP RUL (brief pulse right unilateral) (at 5-6 times seizure threshold)
  • BP BF (bifrontal) at 1.5-2.0 times seizure threshold
111
Q

Recommendation for maintenance pharmacotherapy post-ECT

A

Use either

  • An antidepressant that has not been tried prior to ECT
  • Nortriptyline + Lithium
  • Venlafaxine + Lithium
112
Q

First-line physical and meditative CAMs for MDE (monotherapy and adjunctive)

A
  • Exercise for mild to moderate MDD in monotherapy
  • Light therapy in monotherapy for seasonal (winter) MDD
113
Q

Second-line physical and meditative CAMs for MDE (monotherapy and adjunctive)

A
  • 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
Q

First-line natural health products (monotherapy and adjunctive)

A
  • St. John’s wort for mild to moderate MDD as monotherapy
115
Q

Second-line natural health products (monotherapy and adjunctive)

A
  • 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
Q

First-line for MDD in Children / Youth

A
  • CBT
  • IPT
  • Internet-based psychotherapy (for milder severity, if in-person is not possible)
117
Q

Second-line for MDD in Children / Youth

A
  • Fluoxetine
  • Escitalopram
  • Citalopram
  • Sertraline
118
Q

Third-line for MDD in Children / Youth

A
  • Venlafaxine & TCA (only for > 12 yo)
119
Q

First-line if minimal or nonresponse in MDD in Children/Youth

A
  • Add SSRI to psychotherapy
120
Q

Second-line if minimal or nonresponse in MDD in Children/Youth

A
  • Switch for another SSRI (if unresponsive to fluoxetine)
121
Q

Third-line if minimal or nonresponse in MDD in Children/Youth

A
  • Venlafaxine & TCA (for > 12 yo)
122
Q

First-line for TRD in Children / Youth

A
  • SSRI + psychotherapy
123
Q

Second-line for TRD in Children / Youth

A
  • Switch to another SSRI (if unresponsive to SSRI)
124
Q

Third-line for TRD in Children / Youth

A
  • Venlafaxine
  • TCA
  • Neurostimulation treatment (ECT or rTMS)

All if > 12 yo

125
Q

First-line for mild to moderate MDD during pregnancy

A
  • CBT (individual or group)
  • IPT (individual or group)
126
Q

Second-line for mild to moderate MDD during pregnancy

A
  • Citalopram
  • Sertraline
  • Escitalopram
127
Q

First-line for mild to moderate postpartum depression during breastfeeding

A
  • CBT
  • IPT
128
Q

Second-line treatment for mild to moderate postpartum depression during breastfeeding

A
  • Citalopram
  • Escitalopram
  • Sertraline
  • Combination SSRI + CBT + IPT
129
Q

First-line for perimenopausal MDD

A
  • Desvenlafaxine
  • CBT
130
Q

Second-line treatment for perimenopausal MDD

A
  • Transdermal estradiol
  • Citalopram
  • Escitalopram
  • Duloxetine
  • Venlafaxine XR
  • Mirtazapine
  • Quetiapine XR
131
Q

First-line treatment for late-life depression

A
  • Duloxetine, Mirtazapine, Nortriptyline (level 1)
  • Desvenlafaxine
  • Venlafaxine
  • Citalopram
  • Escitalopram
  • Bupropion
  • Sertraline
  • Vortioxetine
132
Q

Second-line treatment for late-life depression

A

A) Switch to

  • Nortriptyline
  • Moclobemide
  • Phenelzine
  • Quetiapine
  • Trazodone
  • Bupropion

B) Combine with

  • Aripiprazole
  • Lithium
  • Methylphenidate
133
Q

What are antidepressant discontinuation symptoms?

A

FINISH

1) Flu-like symptoms
2) Insomnia
3) Nausea
4) Imbalance
5) Sensory disturbances
6) Hyperarousal

134
Q

What is the standard protocol for light therapy and when is the expected response?

A

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
Q

What are the criteria for persistent depressive disorder?

A

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
Q

What is the age criteria for early-onset PDD?

A
  • before 21
137
Q

What are the three different types of persistent depressive disorder?

A
138
Q
  • What is the age criteria for DMDD?
A
139
Q

What is the most recommended contraceptive for PMDD?

A
  • Yasmin / YAZ (drospirenone-containing OCP)
140
Q
A

Nik essentials guidelines (6 decks)

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