Major Depressive Disorder Flashcards
what are risk factors for depression?
age
migraines
hypothyroidism
alcohol/substance abuse disorders
previous episodes
stress
family history
how do we interpret the PHQ-9 score?
1-4: minimal
5-9: mild
10-14: moderate
15-19: moderately severe
20-27: severe
recommended length of therapy for antidepressant is _______ months
6-9
avoid prescribing bupropion if patient has?
seizure disorder or anorexia
SSRIs are specifically _______ antagonists
5-HT1
fluoxetine is approved for _____ due to higher binding affinity for (serotonin R subtype)
bulimia
5HT2C
avoid prescribing fluoxetine to which age population due to a long half-life?
older adults
use caution in prescribing citalopram to patients over 60 y/o and do not exceed ____ mg due to having the highest risk of ___________
20
QT prolongation
what are SEs of SSRIs?
decreased BP, sexual dysfunction, anxiety, and weight loss
avoid using SNRIs if patient has _______
hypertension
do not use duloxetine for patients who have _______ dysfunction
liver
what is mirtazapine used for?
unintentional weight loss
sexual dysfunction (add-on to SSERI/SNRI)
insomnia
1st gen antipsychs should be avoided for patients with?
parkinsons (EPDS ADR), arrhythmias (QT prolongation), and low BP (hypotension/sedation)
1st gen antipsychs can cause hyper___________ and __________
hyperprolactinemia, weight gain
2nd gen antipsychs are used as adjunct therapy after SSRIs and SNRIs, what are the preferred agents used for MDD?
avoid using them for what reasons?
aripiprazole, brexpiprazole, and quetiapine ER
uncontrolled BG (diabetes), hyperlipidemia, and low BP
lithium requires additional yearly check-ins for?
thyroid, renal, and calcium
what are TCA’s used as third line treatment for?
migraine prevention
insomnia
neuropathy
resistant MDD to avoid sexual dysfunction
avoid using TCAs for people with?
arrhythmias (QT prolongation), people with suicide ideation, elderly, and seizure disorders (lowers seuizure threshold)
what are newer antidepressants that can be considered as 2nd line therapy if pt not tolerating SSRI or SNRI?
vortioxetine, vilazodone, and levomilnacipran
what are the SSRIs you don’t know off the top of your head?
paroxetine, fluvoxamine, and vortioxetine
which SSRI is a potent inhibitor of CYP2D6?
paroxetine
what are the SNRIs used for MDD?
venlafaxine
desvenlafaxine
duloxetine
what questions are asked in the phq2?
little interest or pleasure doing things
feeling down, depressed, or hopeless (in the last 2 weeks)
list the TCAs
amitriptyline
nortriptyline
desipramine
doxepin
