L69 - Ott depression Flashcards
risk of recurrence in depression
1 episode: __%
2 episodes: ___%
3 episodes __ %
50-60
70
90
Acronym for DSM-5 diagnostic criteria
SIGE CAPS
Sleep
Interest decreased
Guilt/ worthlessness
Energy loss/ fatigue
Concentration difficulties
Appetite changes
Psychomotor
Suicidal ideation
Higher suicide risk
Longer duration of illness
Poor treatment response
A. w/ anxious distress
B. w/ melancholic features
C. w/ atypical features
A
Anhedonia
Psychomotor retardation/agitation -> worse in the morning, more likely in elderly
A. w/ anxious distress
B. w/ melancholic features
C. w/ atypical features
B
Reactive mood
Weight gain
Hypersomnia -> more likely in younger patient
A. w/ anxious distress
B. w/ melancholic features
C. w/ atypical features
C
3 self-administered rating scales
PHQ-9
QIDS-SR-16
MDQ
name the 3 phases of tx
acute
continuation
maintenance
the boxed warning for suicide in all antidepressants is for what age?
24 and below
what is the only ssri that does not require a taper
fluoxetine
what ssri has more GI upset than the others
sertraline
which ssri has dose dependent QTc prolongation
Citalopram
2C19 and 3A4 substrate ssri
citalopram
2D6 and 3A4 inhibitor ssri
fluoxetine
1A2 and 2C9 ssri
fluvoxamine
avoid in pregnancy
paroxetine
paroxetine CYPs
2D6 and 2B6
3 key adverse effects across all SSRIs
increased bleeding
hyponatremia
sexual dysfxn
specific paroxetine adverse effect (not related to pregnancy )
weight gain
specific adverse effect for fluoxetine
weight loss
Desvenlafaxine CYPS
none
SNRI with dose-limiting side effect of nausea
Desvenlafaxine
SNRI with FDA warning for hepatotoxicity
duloxetine
duloxetine CYP(s)
2D6
SNRI that you MUST adjust in renal impairment or strong 3A4 inhibitors
Levomilnacipran (fetzima)
SNRI that must be >150 mg/day to have NE effects
venlafaxine
which SNRI is a 2D6 inhibitor at higher doses
Venlafaxine
Venlafaxine CYP(s)
2D6 at high doses, and 3A4
2 main SNRI Adverse effects that were highlighted
BP elevation and Nausea
when are SNRI especially useful
musculoskeletal pain, fibromyalgia, neuropathic pain
which SNRI do you obtain LFTs at baseline and when symptomatic or every 6 months
duloxetine
the one single TCA OTT wants us to know
amitriptyline
TCA MOA
blockade of reuptake transporters for DAT NET and SERT
TCA side effects that we care about:
CNS: sedation, reduced seizure threshold, confusion
anticholinergic: you know
cardiovascular: hypotn, tachy
other: weight gain, sexual dysfxn
why are TCAs fatal in OD?
doses as low as 1000mg (4-10 tabs) can cause arrhythmias or seizures
T or F: TCAs more useful in pain syndromes than in depression
true
what class are the following?
Isocarboxazid, Phenelzine, Selegiline
Tranylcypromine
MAOi’s
all maoi’s require what weird niche thing and with what exception?
tyramine diet, except for selegiline 6mg patch **
caution in MAOis due to ____ and ____
htn crisis and serotonin syndrome
MAOi must have __ week washout period before switching antidepressants
2 weeks, except fluoxetine which is 5 week bc half-life
T or F: MAOis show more efficacy in combo with other antidepressants
F, should always be by themselves
what are some foods included in the tyramine diet
meats, fish, sauerkraut, cheese, yeast extracts, flava beans, beer, wine
tyramine foods in small amounts
beer, wine, avocados, meat extracts, caffeine, chocolate
MOA of bupropion
DA and NE reuptake inhibitor
bupropion stimulates what 2 things
insomnia, appetite supression
bupropion cyp(s)
2d6
bupropion contraindicated in what and what
seizure and eating disorders
what makes mirtazapine a good adjunct drug with ssris?
it boosts effects of ssris
mirtazapine:
Sedation and increased appetite occur with doses < __ mg/day
15, so lower doses
two warnings associated with mirtazapine
agranulocytosis and increased cholesterol
T or F: Lower doses of trazodone are more useful in depression while higher doses are for insomnia
false, other way around
2 highlighted side effects of trazodone
orthostatic hypotension
risk of priapism -> medical emergency **
Vilazodone:
primarily _____ (class), may have some ____ agonism which may provide anxiolytic effects
ssri, 5ht1A
T or F: Vilazodone should not be used as a combo product
true
T or F: Vilazodone should be taken with. food
true
vilazodone cyp(s)
3a4
vortioxetine (trintelllix):
_____ agonist and _____ antagonist
5ht1a, 5ht3
vortioxetine (trintellix) clinical pearl
possibly less sexual dysfunction**
vortioxetine (trintellix) cyp(s)
2d6
highlighted adverse effect of vortioxetine (trintellix)
nausea
T or F: unlike vilazodone, vortioxetine can be used as an adjunct therapy
false, still no… idiot
T or F: serotonin syndrome is considered a medical emergency
true
serotonin syndrome treatment:
- 1st step = ____
- could use serotonin blocker like _______
stop the offending agent
cyproheptadine
T or F: antidepressant withdrawal symptom is a life-threatening medical emergency
false
antidepressant withdrawal symptom is common among all antidepressants except ___
fluoxetine
antidepressants with _____ activity should be tapered no matter what
anticholinergic
4 fda approved atypicals for depression
quetiapine
aripiprazole
cariprazine
brexpiprazole
2 drugs for post-partum depression (with dosage form)
brexanolone (iv only)
zuranolone (oral)
medication used for treatment-resistant depression
esketamine nasal spray
may take how long to see benefits of antidepressant
2-4 weeks
how long do you need to take antidepressants to decrease risk of recurrence
6-9 months (nice)
T or F: There is less risk associated with suicidal thinking within the first few weeks of treatment
false its actually higher
