general info 2

Question 1

True or false - all pt receiving treatment should be monitored for suicidal ideating, particularly in the early weeks of treatment, and for treatment concordance

Answer 1

True

Question 2

When should you review patients on AD after initiation

Answer 2

usually within 2 weeks of initiation
if at risk of suicide or aged 18-25, review 1 week after starting treatment or increasing dose, with ongoing reviews repeated as often as necessary but within 4 weeks

Question 3

AD treatment is usually continued for at least …

Answer 3

6 months

Question 4

management for pt with new episode of subthreshold or mild depression - non drug and drug

Answer 4

psychological and psychosocial therapy e.g. guided self help, CBT, BA
do not routinely offer AD unless pt pref
if this is the case, offer SSRI as appropriate
for pt who decide against treatment offer active motoring with the option to reconsider treatment at any time, and arrange a further assessment (usually within 2-4 weeks)

Question 5

ideal 1st line for pt with new episode of moderate or severe depression

+ other treatment options

Answer 5

combination therapy with AD + individual CBT

monotherapy with AD or psychological treatment (e.g. individual CBT, BA or problem solving) may also be offers as 1st line

Question 6

TCAs are associated with the greatest risk on overdose, although this TCA has the best safety profile

Answer 6

lofepramine

Question 7

Which TCA has the best safety profile

Answer 7

lofepramine

Question 8

Name the 2 SNRIs

Answer 8

venlafaxine
duloxetine

Question 9

when can you consider ECT for the treatment of severe depression

Answer 9

rapid response needed
based on pt prev experience
pt preference over other treatments

Question 10

what to do if pt hasn’t responded after 4 weeks of AD treatment, or after 4-6 weeks of psychological therapy or combined therapy

Answer 10

assess for treatment adherence
consider other factors or health conditions that may explain why treatment is not working

Question 11

For patients with limited or no response to psychological monotherapy, consider the following 3 options

Answer 11

• switch to alt psychological treatment
• add in SSRI
• switch to SSRI alone

Question 12

if there has been limited or no response to AD monotherapy, consider the following options

Answer 12

• add group exercise intervention
• switch to psychological therapy
• increase AD dose
• switch to diff AD in same class or different class
• change to combination psychological and AD

Question 13

For patients with limited or no response to treatment with a combination of psychological therapy and an antidepressant consider the following options

Answer 13

• switching to another psychological therapy
• increasing AD dose
• switch to another AD in same class or different class
• add in another med

Question 14

When can vortioxetine be considered as a treatment option

Answer 14

for pt with limited or no response to at least 2 AD drugs

Question 15

in which situations would you consider referring to specialist mental health setting or seeking specialist advice?

Answer 15

• switching to AD from different drug class e.g. TCA or MAOI
• adding in additional AD form different drug class
• combining AD with either 2nd gen antipsychotic, or lithium
• combining AD drugs with ECT, lamotrigine (unlicensed) or liothyronine (unlicensed)

Question 16

true or false - continuation of treatment following full or partial remission may reduce risk of relapse

Answer 16

true

Question 17

for pt in remission following psychological treatment alone, but who are at higher risk of relapse, consider ..

Answer 17

continuing psychological therapy

Question 18

for pt on AD monotherpay who are in remission but at higher risk of relapse, consider

Answer 18

continuing AD
combing AD with course of psychological therapy (e.g. group CBT or mindfulness-based cognitive therapy MBCT)
switch to course of psychological therapy alone

Question 19

for pt in remission following combination treatment with AD and psychological therapy who are at high er risk of relapse consider

Answer 19

continuing one or both treatments

Question 20

risk of relapse should be assessed on completion of psychological therapy, and at least every …. months for those who continue on AD treatment

Answer 20

every 6 months

Question 21

Some patients presenting with chronic depressive symptoms may not have sought treatment for their depression previously. For patients with symptoms that significantly impair functioning, treatment options include

Answer 21

monotherapy with either CBT or drug treatment with an SSRI, SNRI, or a TCA
or combination therapy with CBT and either an SSRI or a TCA
For patients who do not respond to SSRIs or SNRIs, consider alternative drug treatments in specialist settings or on specialist advice (alternatives include TCAs, moclobemide, irreversible MAOIs, or amisulpride [unlicensed use]).

Question 22

If a patient is taking AD long term to prevent relapse, how often should you review

Answer 22

at least every 6 months to monitor symptoms, check concordance, assess for adverse effects, RF for release, suicidal ideas and their wishes for ongoing treatment
consider using validated questionnaire for depression to monitor response to treatment e.g. PHQ9