depression - SSRIs and SNRIs Flashcards
How long must symptoms be present to diagnose depression?
Most of the day, nearly every day, for at least 2 weeks.
What percentage of the US population experiences depression in their lifetime?
At least 30%.
What are the core symptoms of depression?
Depressed mood, loss of pleasure/interest, insomnia/hypersomnia, anorexia/hyperphagia, mental slowing, loss of concentration, guilt, worthlessness, helplessness, thoughts of death/suicide, suicidal behavior.
What environmental factors contribute to depression?
Prolonged stress, loss of loved one, trauma, childhood events, chronic low self-esteem.
How much more common is depression if a first-degree relative has it?
1.5 – 3 times more common.
What is the Monoamine Hypothesis?
Depression is caused by abnormally low levels of norepinephrine, serotonin, and dopamine.
What tool is used to assess depression?
PHQ-9 (two-question screen first, then full 9-question test).
What is the relationship between suicide and depression?
The majority of people who commit suicide have been diagnosed with major depression.
Why is it important to ask about suicide?
Asking does not give them the idea; it helps assess their risk.
What should you ask if someone says they are suicidal?
Ask if they have a plan and access to means (e.g., a gun at home).
What are the treatment options for depression?
Antidepressants, benzodiazepines ± antipsychotics, psychotherapy (CBT), supportive interventions, ECT, transcranial magnetic stimulation.
What are some supportive interventions for depression?
Self-help books, yoga, relaxation training, light therapy, exercise, tai chi, music, acupuncture.
What is the time course for antidepressant response?
Initial: 1–2 weeks (mood might improve), Full: ~4 weeks, Maximal: 6–12 weeks, Failure: No response in 1 month.
Why is suicide risk high during early antidepressant treatment?
Neurotransmitter changes can increase energy before mood improves, increasing risk.
What are the five classes of antidepressants?
SSRIs, SNRIs, TCAs, MAOIs, Atypical Antidepressants.
What are some common SSRIs used for depression?
Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Fluvoxamine (Luvox).
Which SSRIs are also used for anxiety?
Escitalopram, Paroxetine, Sertraline, Citalopram, Fluoxetine, Fluvoxamine.
What are the early side effects of SSRIs?
Nausea, diaphoresis, tremor, fatigue, drowsiness (often resolve over time).
What are the major adverse effects of SSRIs?
Sexual dysfunction, CNS stimulation (insomnia, agitation, anxiety), Neuroleptic Malignant Syndrome (NMS), suicidal thoughts, weight loss (initially), then weight gain.
What are symptoms of Neuroleptic Malignant Syndrome (NMS)?
Fever, respiratory distress, tachycardia, seizures.
What is serotonin syndrome?
Too much serotonin, causing confusion, tachycardia, sweating, insomnia, agitation. Mnemonic: HARMFUL.
What is withdrawal syndrome from SSRIs?
Can occur days to weeks after stopping, lasts 1–3 weeks.
What uncommon side effects can SSRIs cause?
Hyponatremia, rash, sleepiness, faintness, lightheadedness, GI bleeding, bruxism (teeth grinding).
Are SSRIs safe in pregnancy/lactation?
Try to avoid but may be necessary for the mother’s health.
