Exam 5 (final) - Ott depression Flashcards by Alton Adams

DSM-5 diagnostic criteria says at least one of the symptoms needed to see to diagnose with depression is __________ or ___________

depressed mood, loss of interest or pleasure in doing things

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(in diagnostic criteria) SIGE stands for:

sleep (too much or too little)
interest decreased
guilt/worthlessness
energy loss/fatigue

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(in diagnostic criteria) CAPS stands for:

concentration difficulties
appetite change (increase or decrease)
psychomotor agitation
suicidal ideation

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PHQ-9 is for

primary care setting
-used repeatedly to determine efficacy of treatment
5=minimal
10=mild
15=moderately-severe
20=severe

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MDQ is for

used to rule out BPD
-5 questions
positive score of BPD is when >7 yes responses occur

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boxed warning for ALL antidepressants aged 24 or younger

suicidality
-especially relevant in first 1-2months of therapy and after any dose changes

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citalopram clinical pearls (SSRI)

QTc prolongation
2C19 and 3A4 substrate

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fluoxetine clinical pearls (SSRI)

long t1/2 (96-144 hrs)
2D6 inhibitor, 3A4 inhibitor

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fluvoxamine clinical pearls (SSRI)

inhibitor of 1A2 and 2C19

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paroxetine clinical pearls (SSRI)

must taper due to anticholinergic effects
-weight gain, sedation
birth defect to septal wall of fetus
inhibitor of 2D6 and 2B6

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sertraline clinical pearls (SSRI)

GI upset (more than other antidepressants)

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SSRI SE

weight gain (most with paroxetine)
weight loss (most with fluoxetine)
sexual dysfxn
hyponatremia
increased bleed risk (platelet inhibition)

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desvenlafaxine clinical pearls (SNRI)

active metabolite of venlafaxine
nausea is big issue
no major CYP interactions

14:1, 5HT:NE

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duloxetine clinical pearls (SNRI)

titrate up to avoid nausea
warning for hepatotoxicity (monitor LFTs)
inhibitor of 2D6

10:1

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levomilnacipran clinical pearls (SNRI)

adjust dose for:
-renal impairment
-strong 3A4 inhibitors
3A4 substrate

1:2

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venlafaxine clinical pearls (SNRI)

must be >150mg/day to get NE effects
2D6 inhibitor at high doses

30:1

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SNRI SE

increased BP
nausea

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TCAs inhibit _______

reuptake of DA, 5HT, NE
-block DAT, SERT, NET

amitriptyline (Elavil) dose range

50-300mg/day
-lower doses used for neuropathic pain

TCAs CNS SE

reduce seizure threshold
confusion

TCAs anticholinergic SE

blurred vision
urinary retention
constipation

TCAs CV SE

orthostatic hypotension
tachycardia

TCAs other SE

weigh gain
sexual dysfxn

why does amitriptyline have a narrow therapeutic index

cardiac arrhythmias or seizures in doses as low as 1000mg

MOAi clinical pearls

-2 week wash out period before switching to this from other antidepressants (5 weeks if fluoxetine) -require tyramine diet -caution due to hypertensive crisis and serotonin syndrome

selegiline patch does not require _______ like other MAO inhibitors

tyramine diet

bupropion _______ (does or does not) affect serotonin

does not

bupropion MOA

DA and NE reuptake inhibitor

bupropion clinical pearls

2D6 inhibitor CI in active seizure disorders and eating disorders can be used in combo w/ SSRIs and/or SNRIs

mirtazapine (Remeron) clinical pearls

warnings: agranulocytosis, increased cholesterol can be used in combo w/ SSRIs and/or SNRIs

mirtazapine (Remeron) dosing and reason for dosing

7.5-45mg/day -sedation and increased appetite occur with doses <15mg/day

trazodone (Desyrel) dosing for depression

150-600mg

trazodone (Desyrel) SE

orthostatic hypotension risk of priapism (prolonged erection) sedation? - H1 receptor antagonist

Vilazodone (Viibryd) MOA

primarily SSRI -may have some anxiolytic properties due to 5HT1a agonism

Vilazodone (Viibryd) clinical pearls

-DO NOT use with SSRIs and/or SNRIs -take with food (to decrease nausea and increase bioavailability) -3A4 substrate

vortioxetine (Tritellix) MOA

primarily SSRI with some 5HT1a agonism and 5HT3 antagonism

vortioxetine (Tritellix) clinical pearls

-DO NOT use with SSRIs and/or SNRIs -possibility of sexual dysfxn -2D6 substrate

vortioxetine (Tritellix) SE

N -also V and C

serotonin syndrome treatment

-stop offending agent -wait (70% of pts recover in 24hrs)

only antidepressant with no risk of withdrawal

fluoxetine

augmentation agent options (antipsychotics)

aripiprazole (Abilify) brexpiprazole (Rexulti) cariprazine (Vraylar) quetiapine (Seroquel)

Ott's favorite augmentation agent and the dose she uses

aripiprazole with dose of 2-5mg (for pt already on SSRI and almost to remission)

steps to manage depression

1. dose optimization 2. switch antidepressant agents 3. combine antidepressants 4. augmentation 5. esketamine, ECT/VNS/TMS