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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
how often is ECT
2-3 times a week | 6-12 treatments
26
adverse effects of ECT
confusion memory loss CV dysfunction
27
examples of SSRIs
fluoxetine-kids sertraline paroxetine citalopram
28
advantage of SSRIs
less side effects bc it doesnt block muscarinic, histamine and alpha sites
29
serotonin adverse effects
``` activatin - nervous insomnia - paroxetine GI initially weight gain kinda sexual dysfunction lots ```
30
SSRI tosic effects
``` tremor tachycardia seizure obtundation - full alertness bradycardia treat with charcoal ```
31
serotonin syndrom effects
cognitive - agitation, confusion autonomic - diarrhea, fever, shiver, diaphoresis (sweating) neuromuscular - incoordination, tremor, myoclonus(jerking)
32
causes of serotonin syndrome
MAOi - inhibit serotonin breakdown drugs that block reuptake drugs that enhance release - ectasy serotonin precursors - lsd, lithium
33
treament of serotonin syndrome
neuromuscular - benzos temp - tylenol rigidity - dantrolene severe - cypoheptadine
34
FINISH - SSRI withdrawal symptoms
``` flu like symptoms insomnia nausea imbalance - vertigo, dizzy sensory disturbance - paresthesia hyperarousal - anxiety, agitation ```
35
how long does it take for SSRI withdrawal symptoms to go away
calc how long drug would take to leave body based on half life then add 7 days
36
ways to treat SSRI withdrawal
prevent by gradual tapering increase dose and taper more slow switch to fluoxetine if severe because of long half life and metabolites
37
which SSRI has long half life and active metabolite
fluoxetine
38
whats wrong with grapefruit
decrease cyp 3A4 in the intestine and separating wont prevent interaction causes high level and toxicity
39
SNRI examples
venlafaxine - effexor | duloxetine - cymbalta
40
AE of SNRI
BP changes GI sexual dysfunction dry mouth, constipation
41
NDRI norepinephrin dopamine reuptake inhibitor example
bupropion | good to switch to if lots of serotonin side effects
42
adverse effects of bupropion
activating seizure at high doses ** dry mouth, constipation
43
advantages of bupropion
little weight gain and sexual dysfunction | good if not tolerant to serotonin effects
44
NaSSA | noradrenergic and specific serotonin example
mirtazapine
45
mirtazapine MOA
alpha 2 antagonist - enhances NE adn serotonin release serotonin antagonist - min sex dysfunction, insomnia histamin blocker - potent, weight gain anticholinergic - dry mouth
46
advantages of mirtazapine
little sexual dysfunction | less serotonergic effects
47
what does TCA all block
serotonin and NE reuptake | histamine, muscarinic, alpha receptors
48
major warning in TCAs
cardiac effects | hypertension, tachycardia, antiarrhythmic....
49
high risk patients for cardiac effects with TCAs
elderly CV disease overdose
50
what are the preferred TCAs
tricyclic secondary amines desipramine nortriptyline
51
why might TCAs not be good for the elderly
anticholinergic effects - confusion, sedation, urinary retention
52
AE effects of TCAs
antihistaminic - sedation, weight gain | alpha adrenergic - orthostatic hypotension
53
most common cause of death in TCA overdose
refractory hypotension
54
toxic effect in TCA overdose
CV- QRS prolong, hypotension CNS- seizure, coma hyperthermia
55
TCA withdrawal syndrome
cholinergic and adrenergic rebound - diarrhea, anxiety
56
treat TCA withdrawal
taper over 2-4 weeks to prevent restart at low dose anticholinergic agent
57
MAOis MOA
irreversibly inhibit MAO A and B | takes 2 weeks before new enzyme is synthesized
58
wash out period for MOAs when switching to other antidepressants
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
why do you want to avoid tyramine which is in chesse
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
what food to avoid when using MAOI
``` cheese alcohol fish aged meat over ripe fruit yeast extracts, vit supplements sauerkraut beans ```
61
when do you use MAOis
atypical depression | resistant depression
62
AE of MAOIs
orthostatic hypotension * dry mouth constipation sexual insomnia
63
examples of MAOIs
phenlzine | tranylcypromine
64
what is moclobemide
reversible inhibitor of MAO-A | taken after meals to min tyramine response
65
indication for stjohns wort
mild-mod depression
66
AE and DI from st johns wort
serotonin syndrome, hypomania | cyp inhibitor
67
which are the drugs you need to have a washout before switching
RIMA | MAOI
68
drugs to avoid with seizure disorders
bupropion | TCA
69
drugs to avoid in sexual dysfunction
SSRI venlafaxine TCA MAOI
70
drugs to avoid weight gain
TCA MAOI mirtazapine SSRI - inital loss then regain
71
things you should watch for in the elderly
orthostatic hypotension - alpha block cognition - anticholinergic excessive sedation - histamine block urinary retention - anticholinergic
72
why might you caution venlafaxine use in cardiac patients
increase in blood pressure
73
problem with anticholinergic effect in cardiac patients
increased heart rate
74
what drugs can cause arrythmias
TCAs rare bradycardia with SSRI venlafaxine OD
75
most evidence of safety in pregnancy
fluoxetine | then TCA - nortriptyline
76
are antidepressants safe in breast feeding
excreted in small amounts | try paroxetine, sertraline, fluoxetine, nortriptyline
77
what should you monitor with antidepressants and breast feeding
changes in sleep, feeding pattern, behaviour
78
drug options for children
fluoxetine and citalopram first line | best to combine with CBT
79
why arent TCAs recommended for children
lethal in overdose rare cases of sudden death children are at an increased risk for suicidal behavior - monitor!!
80
how long do you continue treatmetn in children
continue once effective for 6 months | gradually discontinue over 6 weeks

Clinical 2.0 winter (28 decks)

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