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PR3153 > IC12 - Depression > Flashcards

IC12 - Depression Flashcards

1
Q

List the 6 risk factors of depression.

A
  1. Poor
  2. Elderly
  3. Lonely
  4. Man
  5. Comorbidities
  6. Previous attempts
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2
Q

What is the monoamine hypothesis for depression?

A

It refers to a decrease of neurotransmitters in brain (norepinephrine, serotonin, dopamine)

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3
Q

Name 2 medical disorders that are associated with secondary depression.

A
  1. Endocrine Disorders (hypothyroidism)
  2. Cardiovascular (CAD, CHF, MI)
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4
Q

Name 1 drug-induced related cause for depression.

A

Withdrawal from alcohol, stimulants

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5
Q

How is depression diagnosed?

A

DSM 5 for depression - ≥ 5 symptoms present for 2 weeks and represent a change from previous functioning. Symptoms must include depressed mood or loss of interest.

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6
Q

What are the 9 factors in the DSM-5 Diagnostic Criteria for depression?

A
  1. Interest (Loss)
  2. Sleep (Insomnia or hypersomnia)
  3. Appetite (Loss)
  4. Depressed (mood)
  5. Concentration (Impaired)
  6. Activity (Psychomotor retardation or agitation)
  7. Guilt
  8. Energy (Loss)
  9. Suicidal thoughts or attempts
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7
Q

To be diagnosed with depression, symptoms must cause significant ______ or ______ in social, occupational, or other
important areas of functioning.

A

distress, impairment

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8
Q

Depression symptoms should not be caused by _______.

A

medical conditions/ substances

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9
Q

List 2 differential diagnosis of depression.

A
  1. Adjustment Disorder
    (with Anxiety and/or Depressed
  2. Acute Stress Disorder
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10
Q

What is an adjustment disorder?

A

Symptoms occur within 3 months of onset of a stressor but once stressor is terminated, symptoms do not persist for another 6 months

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11
Q

What is acute stress disorder?

A

Symptoms occur within 1 month of a traumatic event and lasts 3 days 1 month.

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12
Q

What are two important assessments that should be done for depression?

A
  1. Assess for psychiatric history
  2. Mental state exams (suicidal/ homicidal thoughts/ risks)
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13
Q

How is depression differentiated from other conditions? Discuss based on onset, consciousness and memory.

A
  1. Cyclical onset
  2. Unimpaired Consciousness
  3. Intact memory
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14
Q

List two psychiatric rating scales that can be used for depression.

A
  1. Hamilton Rating Scale for Depression (HAM-D)
  2. PHQ-9 Questionnaire
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15
Q

How is remission of depression determined in the Hamilton Rating Scale for Depression (HAM-D)?

A

Remission score ≤ 7

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16
Q

When is antidepressant therapy required in the PHQ-9 questionnaire?

A

≥ Moderate in severity (10 points and above)

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17
Q

List three non-pharmacological methods for depression.

A
  1. Sleep hygiene
  2. Psychotherapy (combine with antidepressants)
  3. Neurostimulation (usually severe)
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18
Q

When is the use of antidepressant warranted?

A

moderate to severe depression

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19
Q

List the first line antidepressants that can be used as monotherapy.

A
  1. Mirtazapine
  2. SSRI
  3. SNRI
  4. Bupropion
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20
Q

What is considered an adequate trial in the acute phase treatment of antidepressants?

A

Adequate Trial = adequate dose + duration (4-8wks)

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21
Q

Physical symptoms of depression may take ______ weeks to improve.

A

1-2

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22
Q

Mood symptoms of depression may take ______ weeks to improve.

A

4-8

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23
Q

What is the duration of the continuation phase?

A

Total = 6-12 months at least

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24
Q

List six examples of SSRIs that is used for depression.

A

Fluoxetine, Fluvoxamine, Escitalopram, Citalopram, Paroxetine, Sertraline

25
Q

List three examples of SNRIs that is used for depression.

A

Venlafaxine, Desvenlafaxine, Duloxetine

26
Q

List one example of NaSSA that is used for depression.

A

Mirtazapine

27
Q

Name one norepinephrine dopamine reuptake inhibitor that is used for depression.

28
Q

Name 5 TCAs that can be used for depression.

A

Amitriptyline, Clomipramine, Dothiepin, Imipramine, Nortriptyline

29
Q

What are the side effects of TCAs in depression?

A
  1. GI & sexual dysfunction
  2. Anticholinergic symptoms
  3. Sedation
  4. Death (Fatal on overdoses)
30
Q

Which TCAs have have lower anticholinergic, sedation & cardiotoxic side effects?

A

2 degree amines (Nortriptyline, Desipramine)

31
Q

What are the main side effects of SSRIs?

A

GI & sexual dysfunction

32
Q

What is the half life of fluoxetine?

A

4 to 6 days

33
Q

Which SSRIs is the most anticholinergic, sedating and can weight, and have short T½?

A

Paroxetine

34
Q

Which SSRIs have QTc prolongation risk in elderly at high dose?

A

Escitalopram/ Citalopram

35
Q

What other 3 conditions are duloxetine indicated for apart from depression?

A
  1. Diabetic Peripheral Neuropathy
  2. Fibromyalgia
  3. Chronic musculoskeletal pain
36
Q

What are the side effects of mirtazapine?

A

Somnolence, increase appetite,
weight gain, GI and sexual dysfunction

37
Q

GI and sexual side effects in mirtazapine are _____.

A

reversible

38
Q

Bupropion is not suitable for people with ______ disorder.

39
Q

What are the side effects of bupropion?

A
  1. Seizure
  2. Insomnia
  3. Psychosis
40
Q

What is an advantage of bupropion over SSRI and SNRI?

A

decrease sexual side effect

41
Q

Moclobemide (MAOi) is _____ and safest for depression.

A

reversible

42
Q

MAOi except Moclobemide used in depression can cause _____.

A

Hypertensive crisis

43
Q

List three adjunct 2nd generation antipsychotics medication that can be used for depression.

A
  1. Aripiprazole
  2. Brexpiprazole
  3. Quetiapine XR
44
Q

What is one significant drug-food interaction of antidepressant?

A

St John’s Wort

45
Q

When switching antidepressants from/ to MAOIs, _______ period is needed.

46
Q

What is the washout duration when switching from moclobemide to another antidepressants?

47
Q

What is the wash out period when switching from antidepressant to moclobemide?

A

Minimum one week (5 weeks if stopping fluoxetine)

48
Q

What are some considerations when it comes to elderly?

A
  1. Avoid TCAs
  2. Look out for signs of hyponatremia (drowsy, confused, convulsions)
  3. Suicidality
49
Q

What are the three alternative medications that can be considered if there is a risk of hyponatremia in elderly?

A

Agomelatine, Mirtazapine or Bupropion

50
Q

How is hyponatremia monitored for patients with depression?

A

Monitor serum Sodium at baseline, 2nd week, 4th week, then 3 monthly.

51
Q

What is the mandatory action to take when patient is taking antidepressants?

A

Counselling (Especially in patients ≤ 24 years old due to association to suicidality)

52
Q

Mirtazapine can be considered in ____ patients.

A

underweight

53
Q

List 4 DDI associated with antidepressants.

A
  1. Serotonergic symptoms [Serotonin syndrome (important)]
  2. SSRIs (increase bleed)
  3. CNS depressants i.e. alcohol
  4. Anticholinergic agents
54
Q

What are the antidepressants that have fewer CYP interactions?

A

Mirtazapine, Escitalopram, Venlafaxine, Desvenlafaxine, Vortioxetine

55
Q

What are the symptoms of antidepressants discontinuation syndrome?

A
  1. Flu-like symptoms
  2. Insomnia
  3. Nausea
  4. Imbalance
  5. Sensory disturbances (“electric like” sensations)
  6. Hyperarousal (anxiety)
56
Q

What ate the two drugs that have severe antidepressants discontinuation syndrome?

A
  1. Paroxetine
  2. Venlafaxine
57
Q

Which two antidepressants does not require gradual tapering?

A

Fluoxetine, bupropion

58
Q

How can antidepressants discontinuation syndrome be avoided?

A

Gradual tapering (by half tablet of lowest strength every 1-2 weeks) if patient had been on regular dosing for ≥6-8 weeks.

59
Q

Venlafaxine can cause/ worsen _____.

A

hypertension

PR3153 (16 decks)

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