Exam 4: Depression and anxiety Flashcards
1
Q
Define major depressive disorder
A
Significant impairment of social, academic, and occupational function for ≥2 weeks with 5 or more sx. Depressed mood or lack of enjoyment in pleasurable activities must be included.
2
Q
Persistent Depressive Disorder aka?
A
Dysthymia
3
Q
Persistent Depressive Disorder definition
A
Depressed mood for more days than not for at least 2 years
4
Q
Define bereavement
A
Depressed symptoms occur after loss of loved one
5
Q
Define adjustment disorder
A
Develpment of emotional and/or behavioral symtpoms within 3 months of an identable stressor
6
Q
Major Depressive Disorder lasts for at least how long?
A
≥2 weeks
7
Q
Persistent Depressive Disorder lasts for at least how long?
A
2 years
8
Q
Adjustment Disorder develops when? (hint: time from something)
A
Within 3 months of an identifable stressor
9
Q
Psychotherapy as effective as what for mild to moderate depression?
A
Drugs
10
Q
What must screen for before using antidepressant monotherapy meds?
A
Bipolar disorder
11
Q
Which class of antidepressants is most effective?
A
None. They’re all equally effective.
12
Q
Selecting an antidepressant med depends on what?
A
PT specifics
13
Q
Most commonly rx med for depression?
A
SSRI
14
Q
SSRI indicated for which levels of depression?
A
Mild to moderate
15
Q
SSRI MOA?
A
Increases 5-HT time in synapse resulting in neuronal adaptation
16
Q
What explains why SSRIs take a while to work?
A
neuronal adaptation
17
Q
Which two 5-HT receptors are most likely involved in anxiety and depression?
A
5-HT 1
5-HT 2
18
Q
ADR of 5-HT1?
A
HA
19
Q
Two ADRs of 5-HT2?
A
Somnolence, sexual dysfunction
20
Q
ADR of 5-HT3?
A
Nausea and vomiting
21
Q
ADR of 5-HT4?
A
Diarrhea
22
Q
Which SSRI is worst for sexual side effects and weight gain?
A
Paroxetine
23
Q
Paroxetine side effects due to what?
A
Inhibition of nitric oxide synthase
24
Q
QTc risk and SSRIs?
A
Minimal
25
Which SSRI has biggest QTc risk?
Citalopram 10mg
26
What has greater risk for QTc than SSRIs?
TCAs x2
27
Abrupt cessation of SSRIs can cause what?
Withdrawal symptoms
28
Withdrawal symptoms from SSRIs lasts for how long?
1-10days
29
Are withdrawl sx from SSRIs life-threatening?
Nope
30
Which two SSRIs have worst withdrawal symptoms?
Fluvoxamine>Paroxetine
31
Which 2 SSRis have fewest drug-drug interactions?
1. Escitalopram
| 2. Sertaline
32
SNRIs indicated for what type of depression?
SEVERE
33
SNRI MOA?
Serotonin and Norepinepherine reuptake inhibitor
34
SNRI has same MOA as what other class?
TCAs
35
SNRI and what type of hesitation?
Urinary hesitation
36
TCAs are considered SNRIs with what else?
Severe side effects
37
When to use TCAs?
Only if other meds has failed.
38
Who to NEVER use TCAs in?
Geriatics
39
Can fatally OD on TCAs?
Yes! ACh receptor OD with one week supply.
40
TCAs cause risk of orthostatis through what?
Alpha-1-antagonism
41
TCAs and ADRs?
Constipation, photosensitivity, arrythmias through Na+ channel block
42
SSRIs and Tripans cause what type of head pain?
Migraines
43
Serotonin syndrome due to what?
5-HT1a and 5-HT2a overstimulation
44
Serotonin syndrome symptoms?
REstless, akathisia, tremor, hypomania, confusion, hyperreflexia, myoclonus, diaphoresis, hyperthermia
45
Serotonin syndrome and death through what?
anoxia, aspiraiton, or multiple organ failure
46
When does Serotonin syndrome resolve?
After 24h once proserotogenic agent stopped
47
How to tx Serotonin syndrome?
Cyproheptadine 4mg PRN=5-HT antagonist
48
Antidepressants and preggers?
No meds if possible
49
Antidepressants and preggers and bupropion?
Bupropion safer than SSRIs if no cardiac or seizure comorbidities in mother
50
Antidepressants and preggers and SSRI?
Fluoxetine best studied but not necessarily first choice
51
Which SSRI to never use in preggers?
Paroxetine
52
Which 2 antidepressants have negligible levels in breastmilk?
Sertaline
| Paroxetine
53
Initial antidepressant tx lasts for how long?
4-8 weeks
54
What if only partial response (25%) after 4-8 weeks?
Increase dose
55
If increase dose doesn’t help?
Switch to another antidepressant
56
When is PT considered “Treatment resistant”
2 trials and failrue to adaquetly reduce symptoms
57
What to do for “Treatment resistant”? 4 options
1. Switch to third antidepressant monotherapy in different class
2. add second antidepressant from different class
3. Augment with non-antidepressant (Li, T3, atypical antipsychotics)
4. Non-pharm options
58
Most common combos?
SSRI + Bupropion (stimulant)
| SSRI + Mirtazzpine (for sleep)
59
What guides choice for combo selection?
By effects of second agent
60
What to never combi SSRI/SNRI/TCA with?
MAOI
61
Dose of atypical antipsychotic augmentation is lower than what? Response rate?
Schizphrenia dose. 20% response with 2 week onset.
62
When to assess tolerability and safety/suicidal thoughts?
10-14 days after starting treatment
63
When to assess efficacy?
4 weeks after starting treatment
64
When to measure for maximal dose?
6-8 weeks after starting treatment
65
When it “continuing phase”?
Every month for next 4-9 months
66
Is MDD-Pediatrics the same criteria as adults?
Yes
67
What is different in MDD for adults and peds?
Peds may describe different symptoms- poor concentration or procrastination
68
MDD-Peds score for depressed?
>40
69
MDD-Peds score for remission?
<28
70
Tx for MDD-Peds age 8-17?
Fluoxetine
71
Tx for MDD-Peds age 12-17?
Escitalopram
72
Which SSRI to never use in adolescents?
Paroxetine. Poor efficacy and worse tolerability.
73
Young age and placebo response?
High response
74
Young age and suicide risk?
Greatest suicide risk
75
Define Suicidal Ideation
Thoughts of harm without any definitive plans
76
Define Suicidal Acts
Actual attempts
77
Which SSRI has lowest sick of suicidal ideation?
Fluoxetine
78
How often to monitor for suicidal risk with Fluoxetine?
Every 4 weeks
79
Tx for mild depression?
Supportive care
80
Tx for moderate to severe depressive symptoms?
Pharms + Therapy
81
What to 2 to add to SSRI?
Bupropion or Mirtazapine
82
How long to treat depression for?
1 year minimum
83
Define anxiety
Uncomfortable feeling of fear or apprehension accompanied by vague physical feelings (CV and GI)
84
When does anxiety manifest?
Daily, under specific circumstances, mild, intense, acute, chronic
85
What percent of General Anxiety Disorder have depression?
40%
86
What percent of Panic Disorder have depression?
20-90%
87
Define adjustment disorder
Development of emotional and/or behavioral symptoms within 3 months after identifiable stressor
88
Sx of Adjustment Disorder?
Sleep disturbances, depressed mood, eating disorder, worry/jittery
89
How long to sx of adjustment disorder last for?
Less than 6 months after end of stressor
90
First-line tx for anxiety?
BZD
91
BZD MOA?
Bind to GABA-alpha receptor and cause GABA to bind more strongly to receptor making GABA more effective
92
What must be present for BZDs to work?
GABA
93
When does tolerance to sedation occur with BZDs?
2 weeks of daily use
94
When can resporatory depresison occur with BZDs?
When mixed with opiated or alcohol
95
What does long-term BZD use do to conginitive function? What is long-term defined?
Long-term=180 days
| Permanent memory change/impairment
96
Can BZD-caused cognitive impairment get better?
Improved within 1 month of cessation but not full recovery
97
What disease does longer BZD use positively correlate with?
Alzheimers
98
BZD withdrawal does what to anxiety?
Worse anxiety than before
99
BZD withdrawal does what to disinhibition?
Impulsive outbursts can happen is predisposed
100
Duration of BZD taper?
5 weeks
101
BZD frequent dose increase can be a sign of what?
Abuse of diversion
102
Are BZDs used for inducing euphoria?
Rarely
103
BZDc can be added to other drugs to achieve what?
Prolnged high
104
Is BZD increase dose common?
No!
105
What criteria are used for BZD selection?
1. High vs low potency
| 2. Duration of action
106
Which 2 BZDs have fast onset?
1. Alprazolam
| 2. Diazepam
107
Define General Anxiety Disorder
Excessive anxiety and worry for more days than not for at least 6 months
108
Who gets GAD more commonly? men or women?
Female
109
Where is GAD commonly seen?
Primary care
110
Sx of GAD in primary care include?
HA, palpitations, sweating, GI disturbances (diarrhea)
111
Best TX for GAD?
Fluoxetine
112
Fluoxetine and GAD best med for what?
Best for response and remission
113
Which GAD med best tolerability?
Sertaline
114
Which med is specific to GAD only?
Buspirone
115
Buspirone MOA?
5-HT1a partial agonist
116
Buspirone onset?
2 weeks
117
Buspirone full effect?
6 weeks
118
Buspirone and sex dysfunction?
Nope!
119
Which 2 meds have worse outcomes for GAD?
1. Venlafaxine
| 2. Paroxetine
120
What sort of dose to use when treating GAD? Why?
Low dose. Higher dose may initially worsen anxiety.
121
What to add for short-term crisis in GAD?
BZD
122
GAD tx if cannot tolerate SSRI/SNRI?
Pregabalin
123
Define panic attack
Period of intense fear with symptoms develop abrutly and peak in minutes
124
Tx for maintenance of Panic Attacks?
SSRI or SNRI
125
What to use for bridge in panic attack tx?
BZD
126
Venlafaxine (Effexor) and BP?
Increases sytolic by 3-15. Can cause HTN crisis.
127
Desvenlafaxine (Pristiq) more effective than other SNRIs?
Yes
128
Desvenlafaxine (Pristiq) ADRs compared to Effexor?
More CV and BP increase than Venlafaxine (Effector).
129
Bupropion works on which 2 neurotransmitters?
1. Dopamine
| 2. NE
130
Mirtazapine MOA?
Alpha-2 blocker causing increased 5-HT and NE
131
Mirtazapine good for what?
Sleep
132
Duloxetine (Cymbalta) good for what neuro problem?
Neuropathy
133
Duloxetine (Cymbalta) and liver?
Hepatotoxicity with chronic alcohol dependence
134
Trazadone MOA?
Serotonin reputake pump inhibitor. Blocks 5-HT2 receptor decreasing anxiety.
135
Trazadone and risk for serotonin syndrome?
Can give with another SSRI without worry of serotonin syndrome.
136
Trazadone works to block what other things? (hint: 2)
1. Potent antihistaminic blocker
| 2. Alpha 1 noradrenergic blocking effect
