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.
Which drugs are contraindicated with SSRIs?
TCAs and MAOIs (must wait 14+ days).
What conditions require caution when using SSRIs?
Liver/kidney dysfunction, cardiac disease, seizures, diabetes, ulcers, history of GI bleed.
Which drugs interact with SSRIs?
TCAs, MAOIs, St. John’s Wort.
Which drugs does Fluoxetine interact with?
Warfarin, TCAs, Lithium, NSAIDs.
What neurotransmitters do SNRIs affect?
Serotonin and norepinephrine.
What are common side effects of SNRIs?
Nausea, anorexia, weight loss, headache, insomnia, anxiety.
What are cardiovascular side effects of SNRIs?
Hypertension, tachycardia.
What are serious side effects of SNRIs?
Suicidal thoughts, dizziness, blurred vision, serotonin syndrome, neuroleptic malignant syndrome (NMS).
What withdrawal symptoms can occur with SNRIs?
Symptoms can occur if stopped abruptly.
Are SNRIs safe in pregnancy/lactation?
Use with caution.
What conditions require caution with SNRI use?
Older adults, bipolar disorder, mania, seizure disorder, recent MI, hypertension, liver/kidney impairment, interstitial lung disease.
Which substances interact with SNRIs?
MAOIs (14+ days), St. John’s Wort, alcohol, CNS depressants, kava, valerian.
What neurotransmitter does Bupropion primarily affect?
Dopamine.
What is Bupropion used for?
Depression, smoking cessation, counteracting SSRI/SNRI sexual dysfunction.
Why might Bupropion be preferred over SSRIs/SNRIs?
It increases libido and does not cause weight gain.
What are common side effects of Bupropion?
Headache, dry mouth, GI upset, constipation, increased HR, hypertension, restlessness, insomnia.
What serious side effect is associated with Bupropion?
Seizures (avoid in patients with a history of seizures or head injury).
Which drugs should Vilazodone NOT be used with?
SSRIs, SNRIs, MAOIs.
What food/drink should be avoided with Vilazodone?
Grapefruit juice.
What is the primary use of Mirtazapine (Remeron)?
Depression treatment, especially to help with sleep.
Why might Mirtazapine be preferred over SSRIs?
It causes less sexual dysfunction.
What are common side effects of Mirtazapine?
Sleepiness, weight gain, elevated cholesterol.
When should Mirtazapine be taken?
At bedtime.
What is the primary use of Trazodone ER?
Used with another antidepressant, mainly to help with sleep.
What are common side effects of Trazodone?
Very sedating, priapism (prolonged erection).
What food should be avoided with Trazodone?
Grapefruit juice.
