Depressive Disorder Flashcards
How do depression present in the elderly
relatively high MOCA score
health anxiety,
agitation and sleep disturbance
Insomnia
Management of depression
SSRIs are first line fluoxetine , sertraline , citalopram
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Switching to an antidepressant that is not an SSRI is recommended if a second SSRI produces minimal to no response.
Choices for switching include mirtazapine, bupropion, and venlafaxine
what is the third line treatmnet for depression
non selective MAOI (selective for Parkinson’s ) - isocarboxazid
- tranylcypromine
TCA - Amitriptyline · Amoxapine · Desipramine
TCA / amitriptyline is not used that often why ?
(adverse side-effect profile of TCAs more of an issue in the elderly) -
Side effects of TCA overdose ?
main effect of TCAs is to increase serotonin and noradrenaline in the brain by slowing re-uptake, they also block histamine, cholinergic and alpha 1 receptors.
not good in elderly - anti-cholinergic effects give dilated pupils, dry skin, confusion, urinary retention and tachycardia.
DIVERGENT PUPILS
what are the cardiotoxic side effects of TCA ?
potential prolongation of the QTc interval and a widened QRS complex. This can potentially lead to ventricular arrhythmias.
neurological side effect of TCA ?
reduced Glasgow coma scale
In overdose sertraline may present with serotonin syndrome but how can we differentiate that from TCA overdose ?
but skin would not be dry
No QT prolongation (CITALOPARM AN EXCEPTION)
x
x
common side effects of serotonin syndrome due to SSRI toxicity ?
low Glasgow coma scale
dilated pupils
hyperreflexia, often with muscle rigidity and tremor
what is a common side effect of mirtazapine
agranulocytosis
Management of refractory depression
Lithium
Electroconvulsive therapy
shown to be as effective as tricyclic antidepressants in the treatment of mild-moderate depression?
St John Wart
x
