Depression Pharmacotherapy Flashcards
pattern of recurrence with episodes
more episodes = higher recurrence rate
what is the acronym for diagnosing depression
SIGECAPS
what is SIGECAPS
Sleep
Interest decreased
Guilt/Worthlessness
Energy Loss/Fatigue
Concentration trouble
Appetite changes
Psychomotor agitation
Suicidal ideation
what must one symptom be for diagnosing depression
at least one symptom must be depressed mood or loss of interest or pleasure in doing things
what are the self rating scales for depression
PHQ-9
MDQ
what are the goals of treatment for depression
- decrease signs and symptoms of depression
- restore functioning to baseline
- decrease risk of relapse and recurrence
- decrease risk of suicide ideation
what is the boxed warning for all antidepressants
suicidality risk for all antidepressants for patients under 24 years old
Citalopram class
SSRI
citalopram side effect
dose dependent QTc prolongation
citalopram CYPs
CYP2C19 substrate
CYP3A4 substrate
fluoxetine class
SSRI
fluoxetine half-life
long half life
fluoxetine cyps
2D6 inhibitor, 3A4 inhibitor
tapering fluoxetine
do not need to taper
fluvoxamine cyps
inhibits cyp 1A2 and 2C19
paroxetine class
SSRI
paroxetine side effects
weight gain and sedation
septal wall defect risk to fetus
paroxetine tapering
must taper due to anticholinergic effects
paroxetine cyps
inhibits 2D6 and 2B6
sertraline class
SSRI
sertraline major SE
more GI upset
adverse effects of all SSRIs
weight gain/loss
increased bleeding risk
hyponatremia
sexual dysfunction
Desvenlafaxine class
SNRI
desvenlafaxine side effects
dose limiting side effect of nausea
Duloxetine class
SNRI
duloxetine side effects
nausea (slow titration)
hepatotoxicity
duloxetine cyps
2D6
levomilnacipran class
SNRI
when to make levomilnacipran adjustments
renal impairments or strong 3A4
venlafaxine class
SNRI
venlafaxine cyp
2D6 inhibitor
amitriptyline class
TCA
adverse effects for SNRIs
increase in BP
nausea
what labs to get for duloxetine
LFTs
what is amitriptyline mostly used for
pain syndromes
adverse effects of amitriptyline
only at higher doses
decreased seizure threshold
anticholinergic
CV
weight gain
sexual dysfunction
MAOI washout period
2 week washout before switching or 5 weeks for fluoxetine
diet requirements for MAOIs
tyramine diet
except selegiline patch
when to caution use of MAOIs
HTN crisis
serotonin syndrome
Buproprion MOA
dopamine and NE reuptake inhibitor
stimulates insomnia and appetite suppression
Buproprion dosing in depression
XL only
buproprion pearls
2D6 inhibitor
CI in active seizure disorder and eating disorder
can be used in combo with SSRI/SNRI
mirtazapine side effects
sedation and increased appetite w/ dosed under 15mg
mirtazapine warning
agranulocytosis and increased cholesterol
vilazodone MOA
SSRI may have some 5HT1a agonism and prove anxiolytic effects
vilazodone combination therapy
DO NOT combine with SSRI/SNRI
vilazodone pearls
take w/ food
substrate 3A4
