Major Depressive Disorder

Question 1

what are risk factors for depression?

Answer 1

age
migraines
hypothyroidism
alcohol/substance abuse disorders
previous episodes
stress
family history

Question 2

how do we interpret the PHQ-9 score?

Answer 2

1-4: minimal
5-9: mild
10-14: moderate
15-19: moderately severe
20-27: severe

Question 3

recommended length of therapy for antidepressant is _______ months

Answer 3

6-9

Question 4

avoid prescribing bupropion if patient has?

Answer 4

seizure disorder or anorexia

Question 5

SSRIs are specifically _______ antagonists

Answer 5

5-HT1

Question 6

fluoxetine is approved for _____ due to higher binding affinity for (serotonin R subtype)

Answer 6

bulimia
5HT2C

Question 7

avoid prescribing fluoxetine to which age population due to a long half-life?

Answer 7

older adults

Question 8

use caution in prescribing citalopram to patients over 60 y/o and do not exceed ____ mg due to having the highest risk of ___________

Answer 8

20
QT prolongation

Question 9

what are SEs of SSRIs?

Answer 9

decreased BP, sexual dysfunction, anxiety, and weight loss

Question 10

avoid using SNRIs if patient has _______

Answer 10

hypertension

Question 11

do not use duloxetine for patients who have _______ dysfunction

Answer 11

liver

Question 12

what is mirtazapine used for?

Answer 12

unintentional weight loss
sexual dysfunction (add-on to SSERI/SNRI)
insomnia

Question 13

1st gen antipsychs should be avoided for patients with?

Answer 13

parkinsons (EPDS ADR), arrhythmias (QT prolongation), and low BP (hypotension/sedation)

Question 14

1st gen antipsychs can cause hyper___________ and __________

Answer 14

hyperprolactinemia, weight gain

Question 15

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?

Answer 15

aripiprazole, brexpiprazole, and quetiapine ER
uncontrolled BG (diabetes), hyperlipidemia, and low BP

Question 16

lithium requires additional yearly check-ins for?

Answer 16

thyroid, renal, and calcium

Question 17

what are TCA’s used as third line treatment for?

Answer 17

migraine prevention
insomnia
neuropathy
resistant MDD to avoid sexual dysfunction

Question 18

avoid using TCAs for people with?

Answer 18

arrhythmias (QT prolongation), people with suicide ideation, elderly, and seizure disorders (lowers seuizure threshold)

Question 19

what are newer antidepressants that can be considered as 2nd line therapy if pt not tolerating SSRI or SNRI?

Answer 19

vortioxetine, vilazodone, and levomilnacipran

Question 20

what are the SSRIs you don’t know off the top of your head?

Answer 20

paroxetine, fluvoxamine, and vortioxetine

Question 21

which SSRI is a potent inhibitor of CYP2D6?

Answer 21

paroxetine

Question 22

what are the SNRIs used for MDD?

Answer 22

venlafaxine
desvenlafaxine
duloxetine

Question 23

what questions are asked in the phq2?

Answer 23

little interest or pleasure doing things
feeling down, depressed, or hopeless (in the last 2 weeks)

Question 24

list the TCAs

Answer 24

amitriptyline
nortriptyline
desipramine
doxepin