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Clinical 2.0 winter > Despressive disorders > Flashcards

Despressive disorders Flashcards

1
Q

space digs

symptoms for major depression

A 
sleep
psychomotor
appetite
concentration decreased
energy decreased
depressive mood
interest decreased 
guilt/worthlessness
suicide
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2
Q

criteria for major depression

A 
presence of symptoms for >2weeks
at least 5 symptoms present 
not due to a death 
cause significant distress
occur nearly every day
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3
Q

additional symptoms of depression

A

cognitive - decreased concentration and memory
psychotic- hallucinations
physical - depression can cause physical symptoms, decreased libido and hygiene

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4
Q

some examples of secondary causes of depression

A 
thyroid disorder
stroke
aids
MS
alcoholism
anxiety ....
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5
Q

is what a family member is responsive to a sign of what another family member will respond to

A

no

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6
Q

non pharms

A

cognitive behavioural therapy
interpersonal
bright light therapy
exercise

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7
Q

explain the time course of major depression

A

lasts 6-24 months

often episodic recurrent episodes

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8
Q

acute treatment goals

A

shorten episode
decrease symptoms
restore function

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9
Q

chronic treatment goals

A 
eliminate symptoms 
prevent relapse 
min AE of treatment 
min drug interaction 
promote adherence
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10
Q

what does the urgency of treatment depend on

A

severity of symptoms
severity in impairment of function
psychotic symptoms
suicidal risk factors

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11
Q

what are some suicidal risk factors

A 
hopelessness
substance abuse
prior suicidal attempts 
male
suicidal plans
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12
Q

symptom response to treatment

A

anxiety and insomnia - few days
energy - 2nd week
sleep patterns - several weeks
depressed mood, sexual dysfunction - 4th week

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13
Q

how long should we trial a depression med

A

6-12 weeks

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14
Q

what is the health canada advisory on SSRIs

A

severe agitation type adverse events coulped with self harm or harm to others
important to monitor for suicidal behaviour
because they get more energy but are still depressed

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15
Q

first step in treatment

A

start with SSRI and if failing make sure patient is adherant and at an optimal dose

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16
Q

what to do if no response to SSRI

A

switch to another SSRI or a non SSRI
can do up to 3 switches
if there was a partial response can consider augmentation (lithium, second antidepresant, thyroid hormone)

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17
Q

what to do if there is a response to an antidepressant

A

continue for 4-9 months

then 12-26 months maintanence if necessary

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18
Q

which combo therapy do you want to avoid

A

NEVER SSRI AND MAOI

TCA and MAOI - serotonin syndrome

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19
Q

examples of some combo therapies

A

venlafaxine and bupropion
SSRI and bupropion
SSRI and TCA

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20
Q

what are some augmentation treatments

A

T4 and T3- even if status normal thyroid tests dont predict response
VPA
atypical antipsychotics
lithium

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21
Q

diffeence between remission and recovery

A

symptoms go away

recovery is remission lasting 6-12 months

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22
Q

duration of treatment

A

4-9 months after remission

lifelong if <40 and 2+ episodes or anyone with 3+ episodes

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23
Q

what is poop out syndrome

A

antidepressant losses reponse overtime

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24
Q

who are candidates for ECT

A

need a rapid response - suicidal, psychotic
history of poor response to meds
pregnancy

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25
Q

how often is ECT

A

2-3 times a week

6-12 treatments

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26
Q

adverse effects of ECT

A

confusion
memory loss
CV dysfunction

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27
Q

examples of SSRIs

A

fluoxetine-kids
sertraline
paroxetine
citalopram

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28
Q

advantage of SSRIs

A

less side effects bc it doesnt block muscarinic, histamine and alpha sites

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29
Q

serotonin adverse effects

A 
activatin - nervous
insomnia - paroxetine
GI initially 
weight gain kinda
sexual dysfunction  lots
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30
Q

SSRI tosic effects

A 
tremor 
tachycardia
seizure
obtundation - full alertness
bradycardia 
treat with charcoal
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31
Q

serotonin syndrom effects

A

cognitive - agitation, confusion
autonomic - diarrhea, fever, shiver, diaphoresis (sweating)
neuromuscular - incoordination, tremor, myoclonus(jerking)

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32
Q

causes of serotonin syndrome

A

MAOi - inhibit serotonin breakdown
drugs that block reuptake
drugs that enhance release - ectasy
serotonin precursors - lsd, lithium

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33
Q

treament of serotonin syndrome

A

neuromuscular - benzos
temp - tylenol
rigidity - dantrolene
severe - cypoheptadine

34
Q

FINISH - SSRI withdrawal symptoms

A 
flu like symptoms 
insomnia
nausea
imbalance - vertigo, dizzy
sensory disturbance - paresthesia
hyperarousal - anxiety, agitation
35
Q

how long does it take for SSRI withdrawal symptoms to go away

A

calc how long drug would take to leave body based on half life
then add 7 days

36
Q

ways to treat SSRI withdrawal

A

prevent by gradual tapering
increase dose and taper more slow
switch to fluoxetine if severe because of long half life and metabolites

37
Q

which SSRI has long half life and active metabolite

A

fluoxetine

38
Q

whats wrong with grapefruit

A

decrease cyp 3A4 in the intestine and separating wont prevent interaction
causes high level and toxicity

39
Q

SNRI examples

A

venlafaxine - effexor

duloxetine - cymbalta

40
Q

AE of SNRI

A

BP changes
GI
sexual dysfunction
dry mouth, constipation

41
Q

NDRI norepinephrin dopamine reuptake inhibitor example

A

bupropion

good to switch to if lots of serotonin side effects

42
Q

adverse effects of bupropion

A

activating
seizure at high doses **
dry mouth, constipation

43
Q

advantages of bupropion

A

little weight gain and sexual dysfunction

good if not tolerant to serotonin effects

44
Q

NaSSA

noradrenergic and specific serotonin example

A

mirtazapine

45
Q

mirtazapine MOA

A

alpha 2 antagonist - enhances NE adn serotonin release
serotonin antagonist - min sex dysfunction, insomnia
histamin blocker - potent, weight gain
anticholinergic - dry mouth

46
Q

advantages of mirtazapine

A

little sexual dysfunction

less serotonergic effects

47
Q

what does TCA all block

A

serotonin and NE reuptake

histamine, muscarinic, alpha receptors

48
Q

major warning in TCAs

A

cardiac effects

hypertension, tachycardia, antiarrhythmic….

49
Q

high risk patients for cardiac effects with TCAs

A

elderly
CV disease
overdose

50
Q

what are the preferred TCAs

A

tricyclic secondary amines
desipramine
nortriptyline

51
Q

why might TCAs not be good for the elderly

A

anticholinergic effects - confusion, sedation, urinary retention

52
Q

AE effects of TCAs

A

antihistaminic - sedation, weight gain

alpha adrenergic - orthostatic hypotension

53
Q

most common cause of death in TCA overdose

A

refractory hypotension

54
Q

toxic effect in TCA overdose

A

CV- QRS prolong, hypotension
CNS- seizure, coma
hyperthermia

55
Q

TCA withdrawal syndrome

A

cholinergic and adrenergic rebound - diarrhea, anxiety

56
Q

treat TCA withdrawal

A

taper over 2-4 weeks to prevent
restart at low dose
anticholinergic agent

57
Q

MAOis MOA

A

irreversibly inhibit MAO A and B

takes 2 weeks before new enzyme is synthesized

58
Q

wash out period for MOAs when switching to other antidepressants

A

antidepressant to MAOi - wash out 5 half lives of antidepressant
MAOI to antidepressant - wash out 10-14 days
DO NOT COMBINE WITH OTHER ANTIDEPRESSANTS

59
Q

why do you want to avoid tyramine which is in chesse

A

its a dietary amine that is an agonist and increases NE peripherally which normally little is absorbed bc its metabolized by GI MAOA
with MOAi more will be absorbed
causes hypertensive crisis

60
Q

what food to avoid when using MAOI

A 
cheese
alcohol 
fish
aged meat
over ripe fruit 
yeast extracts, vit supplements
sauerkraut 
beans
61
Q

when do you use MAOis

A

atypical depression

resistant depression

62
Q

AE of MAOIs

A

orthostatic hypotension *
dry mouth constipation
sexual
insomnia

63
Q

examples of MAOIs

A

phenlzine

tranylcypromine

64
Q

what is moclobemide

A

reversible inhibitor of MAO-A

taken after meals to min tyramine response

65
Q

indication for stjohns wort

A

mild-mod depression

66
Q

AE and DI from st johns wort

A

serotonin syndrome, hypomania

cyp inhibitor

67
Q

which are the drugs you need to have a washout before switching

A

RIMA

MAOI

68
Q

drugs to avoid with seizure disorders

A

bupropion

TCA

69
Q

drugs to avoid in sexual dysfunction

A

SSRI
venlafaxine
TCA
MAOI

70
Q

drugs to avoid weight gain

A

TCA
MAOI
mirtazapine
SSRI - inital loss then regain

71
Q

things you should watch for in the elderly

A

orthostatic hypotension - alpha block
cognition - anticholinergic
excessive sedation - histamine block
urinary retention - anticholinergic

72
Q

why might you caution venlafaxine use in cardiac patients

A

increase in blood pressure

73
Q

problem with anticholinergic effect in cardiac patients

A

increased heart rate

74
Q

what drugs can cause arrythmias

A

TCAs
rare bradycardia with SSRI
venlafaxine OD

75
Q

most evidence of safety in pregnancy

A

fluoxetine

then TCA - nortriptyline

76
Q

are antidepressants safe in breast feeding

A

excreted in small amounts

try paroxetine, sertraline, fluoxetine, nortriptyline

77
Q

what should you monitor with antidepressants and breast feeding

A

changes in sleep, feeding pattern, behaviour

78
Q

drug options for children

A

fluoxetine and citalopram first line

best to combine with CBT

79
Q

why arent TCAs recommended for children

A

lethal in overdose
rare cases of sudden death
children are at an increased risk for suicidal behavior - monitor!!

80
Q

how long do you continue treatmetn in children

A

continue once effective for 6 months

gradually discontinue over 6 weeks

Clinical 2.0 winter (28 decks)

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