Depression + Suicide

Question 1

Sleep changes in depression

Answer 1

1- Increased sleep latency and night awakenings, early morning awakening

2- Decreased SWS

3- increased total duration and REM density (esp 1st part night)

4- Decrease REM latency (<60 min instead of 90 min)

most antidepressants suppress REM sleep

Question 2

antidepressants with lower risk sexual s/e

Answer 2

• Agomelatine, buproprion, mirtazapine, vilazodone, vortioxetine = lower risk

Question 3

2nd gen antidepressant that are superior

Answer 3

Superior antidepressants (CANMAT 2023)

Every Moment Sparks Vitality And Clarity

-  Escitalopram (level 1) 
-  Mirtazapine (level 1) 
-  Sertraline (level 1)
-  Venlafaxine (level 1) 

- Agomelatine (level 2)  Citalopram (level 2)

Question 4

1st line adjunctive meds for nonresponse or partial response to AD

2nd line

Answer 4

CANMAT 2016:

1st line:
- Aripiprazole
- Quetiapine
- Risperidone

2nd line:
-Brexpripazole
-Bupropion
-Lithium
-Mirtaz/mianserin
-Modafinil
-Olanzapine
-Triiodothyronine

Question 5

Catatonia criteria

Answer 5

Need 3/12

6 Positive:
- Grimacing
- Mannerism (odd repetitive - ex saluting)
- Stereotypies (repetitive, not purposeful)
- Echolalia
- Echopraxia
- Psychomotor agitation

6 Negative
-Catalepsy (posture against gravity)
-Stupor (absence of motor activity)
-Waxy flexibility
-Negativism (opposition)
-Mutism (absence of response_
-Posturing (maintaining actively a posture)

Question 6

MDD treatment recommendations
ie Rx vs therapy for mild/mod/severe

Answer 6

Recommendations:
- Mild w low dangerosity: psychotherapy or Rx have similar benefits. Psychotherapy preferred bc lower risk. Can consider natural products or digital health intervention
- Mod w low-mod dangerosity:
○ Can do either Rx or psychotherapy, or combo
○ Pharmacotherapy slightly better in acute phase for depressed mood, guilt, SI, anxiety, somatic Sx
○ Psychotherapy, specifically CBT more effective medium to long term (6-12 months)
○ Exercise, natural products, or guided DHI can be considered in monotherapy

- Severe w mod/severe dangerosity: 
	○ Combo Rx + psychotherapy 
	○ If psychotic symptoms, combine AD + APA

Question 7

Psychotherapy treatment of depression (1st, 2nd, 3rd line)

Answer 7

1st line: CBT, IPT, behavioral activation

2nd line: MBCT, CBASP, problem-solving therapy, brief psychodynamic therapy, transdiagnostic psychological treatment of emotional problems

3rd line: ACT, long-term psychodynamic therapy (esp if comorbid PD), metacognitive therapy, motivational interviewing

Question 8

Recommendations for MDE w mixed features

Answer 8

1st line AD
2nd line: lurasidone

Question 9

Recommendations for MDE w cognitive dysfunction

Answer 9

1st line vortioxetine
2nd line bupropion, duloxetine, SSRI

Question 10

Recommendations for MDE w sleep d/o

Answer 10

1st line agomelatine
2nd line: mirtazapine, quetiapine XR, trazodone

Question 11

Recommendations for MDE w somatic symptoms

Answer 11

1st line: duloxetine (pain), bupropion (fatigue)
2nd line: duloxetine (fatigue), other SNRI (pain), SSRI (pain

Question 12

-Recommendations MDE w sleep d/o:

Answer 12

1st line agomelatine, 2nd line mirtazapine, quetiapine XR, trazodone

Question 13

Recommendations MDE + menopause

Answer 13

1st lien: desvenlafaxine, CBT
2nd line: transdermal estradiol > citalopram, duloxetine, escitalopram, mirtax, venlafaxine XR, quetiapine XR
>
see guidelines for rest

Question 14

Recommendations MDE + EtOH

Answer 14

1st line: mirtaz, naltrexone, naltrexone + sertraline
2nd line: antabuse adjunct
3rd line: escitalopram, amitryptiline, desipramine, imipramine, epival, memantine

Question 15

recommendations MDE + ADHD

Answer 15

1st line: bupropion, AD + long acting stimulant, AD + TCC
2nd line: desipramine, nortryptiline, venlafaxine
3rd line: AD + short acting stimulant, AD + atomoxetine, AD + lisdexamfetamine