Depression Pharmacotherapy Flashcards by Madelynn Packer

pattern of recurrence with episodes

more episodes = higher recurrence rate

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what is the acronym for diagnosing depression

SIGECAPS

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what is SIGECAPS

Sleep
Interest decreased
Guilt/Worthlessness
Energy Loss/Fatigue
Concentration trouble
Appetite changes
Psychomotor agitation
Suicidal ideation

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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

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what are the self rating scales for depression

PHQ-9
MDQ

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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

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what is the boxed warning for all antidepressants

suicidality risk for all antidepressants for patients under 24 years old

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Citalopram class

SSRI

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citalopram side effect

dose dependent QTc prolongation

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citalopram CYPs

CYP2C19 substrate
CYP3A4 substrate

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fluoxetine class

SSRI

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fluoxetine half-life

long half life

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fluoxetine cyps

2D6 inhibitor, 3A4 inhibitor

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tapering fluoxetine

do not need to taper

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fluvoxamine cyps

inhibits cyp 1A2 and 2C19

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paroxetine class

SSRI

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paroxetine side effects

weight gain and sedation
septal wall defect risk to fetus

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paroxetine tapering

must taper due to anticholinergic effects

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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