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Neuro - Week 4 > Major Depressive Disorders > Flashcards

Major Depressive Disorders Flashcards

1
Q

Are females or males more likely to have major depression?

A

Women

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2
Q

Major depression rates are highest between these ages

A

19-29 years

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3
Q

“SIG E CAPS” describes the criteria for major depressive disorder, and stands for this

A

Sleep disturbed
Interest or pleasure lost
Guilt increased
Energy depressed
Concentration depressed
Appetite disturbed
Pyschomotor activity disturbed
Suicidal ideation present

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4
Q

What ages are more at risk for suicide?

A

Teenage or older than 45

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5
Q

What gender has more risk for suicide?

A

Males

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6
Q

“SAD PERSONS” describes the risk factors for suicide, and stands for this

A

Sex (male)
Age (<19 or >45)
Depression or hopelessness
Previous suicide attempt or psychiatric care
Excessive alcohol or drug use
Rational thinking loss
Separated, divorced, or widowed
Organized or serious attempt
No social supports
Stated future intent

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7
Q

Subtype of depression with profound anhedonia and dysphoria

A

Major depression with Melancholia

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8
Q

Subtype of depression with criteria met for >2 years

A

Chronic major depression

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9
Q

Subtype of depression with typically milder depression, patients frequently cry

A

Dysthymia

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10
Q

Subtype of depression with mood reactivity
Responses may appear normal for positive events

A

Atypical major depression

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11
Q

Subtype of depression with favorable response to MAOIs

A

Atypical major depression

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12
Q

Postpartum mood disturbances typically occur within this amount of time of delivery

A

1 month

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13
Q

How long does maternal (postpartum) blues last?

A

Short duration ~2 weeks

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14
Q

How long does postpartum depression last?

A

Up to one year

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15
Q

How long does postpartum psychosis last?

A

Up to 2 months

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16
Q

Postpartum mood disturbance that is short duration, and supportive therapy is common and adequate

A

Maternal (postpartum) blues

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17
Q

Postpartum mood disturbance that lasts up to one year and requires antidepressant therapy

A

Postpartum depression

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18
Q

Postpartum mood disturbance that has low incidence, lasts up to 2 months and requires antipsychotic/antidepressant therapy, possible hospitalization, and consideration of child safety

A

Postpartum psychosis

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19
Q

Do symptoms of premenstrual dysphoric disorder improve or worsen after start of menses?

A

Improve

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20
Q

What are the three phases of depression treatment?

A

Acute - remission of symptoms
Continuation - eliminate residual symptoms or prevent their emergence
Maintenance - prevent recurrent

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21
Q

Phase of depression treatment that is remission of symptoms

A

Acute phase (~10 weeks)

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22
Q

Phase of depression treatment that is to eliminate residual symptoms or prevent their emergence

A

Continuation phase (~9 months)

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23
Q

Phase of depression treatment that prevents recurrence

A

Maintenance phase (~36 months)

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24
Q

This may be the first line treatment for mild depression

A

Psychotherapy (if patient is willing)

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25
Q

This depression non-pharmacological therapy is ideal for patients needing rapid response or have failed to respond to pharmacotherapy

A

Electroconvulsive therapy (ECT)
(is repetitive transcranial magnetic stimulation)

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26
Q

Electroconvulsive therapy can be indicated for this condition, especially if psychotic features or catatonia are present

A

Major depressive disorder
(also bipolar, shizophrenia)

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27
Q

What are the three relative contraindications of Electroconvulsive therapy?

A

Cardiovascular disease
Cerebrovascular disease
High anesthetic risk

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28
Q

Is there absolute contraindications of electroconvulsive therapy?

A

None; only relative

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29
Q

Are antidepressants within a class of equivalent efficacy?

A

Yes

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30
Q

This is the long-lived active metabolite of fluoxetine

A

Norfluoxetine (half life of 8 days)

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31
Q

What is the half life of norfluoxetine, the active metabolite of fluoxetine?

A

8 days

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32
Q

Reducing the dose or concurrent use of benzodiazepines may help this adverse effect of SSRIs

A

Insomnia and anxiety

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33
Q

Insomnia and anxiety are adverse effects of SSRIs, and concurrent use of this drug may help

A

Benzodiazepines

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34
Q

This can occur in overdose of SSRIs, and can involve confusion, agitation, autonomic instability, hyperthermia, seizures, hyperreflexia, muscle rigidity, nystagmus, shivering, and seizures

A

Serotonin syndrome

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35
Q

Does serotonin syndrome involve hypothermia or hyperthermia?

A

Hyperthermia

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36
Q

Does serotonin syndrome involve bradycardia or tachycardia?

A

Tachycardia

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37
Q

Can seizures occur with serotonin syndrome?

A

Yes
(due to CNS stimulatory effects)

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38
Q

Withdrawal effects noted following abrupt discontinuation of this type of drug includes paresthesia/electric shock sensation and vivid dreams

A

SSRIs

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39
Q

Are there withdrawal effects from abrupt discontinuation of SSRIs?

A

Yes
(includes paresthesias/electric shock sensation and vivid dreams)

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40
Q

SSRIs have an increase risk of suicide or worsening depression, especially in this much time of therapy

A

First month

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41
Q

This is a shared risk with all antidepressants
Increased risk is not common among patients >24 years old
Risk may be lower among patients >65 years old

A

Suicide

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42
Q

This class of drugs is the first line antidepressants

A

SSRIs

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43
Q

This class of drugs is the second line treatments for depression

A

SNRIs (selective norepinephrine uptake inhibitors)

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44
Q

What type of drug is Fluoxetine?

A

SSRI

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45
Q

What type of drug is Paroxetine?

A

SSRI

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46
Q

What type of drug is Fluvoxamine?

A

SSRI

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47
Q

What type of drug is Venlafaxine?

A

SNRI

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48
Q

What type of drug is Duloxetine?

A

SNRI

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49
Q

Class of antidepressants with an adverse effect of dose dependent increase in BP

A

SNRIs

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50
Q

This class of antidepressants has a higher potential for cardiac arrhythmias, especially at higher doses

A

SNRIs

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51
Q

SNRIs may have dose dependent increase in this

52
Q

Severe withdrawal noted even after missing a single dose noted for this SNRI

A

Venlafaxine

53
Q

Mirtazapine is this type of drug

A

Tetracycline

54
Q

Mirtazapine blocks these two receptors to increase release of serotonin and norepinephrine

A

Alpha-2 and serotonin-2 receptors

55
Q

Antidepressant that blocks presynaptic alpha-2 and serotonin-2 receptors to increase release of serotonin and norepinephrine

A

Mirtazapine (a tetracycline)

56
Q

Mirtazapine blocks presynaptic alpha-2 and serotonin-2 receptors to increase release of these two compounds

A

Serotonin and norepinephrine

57
Q

Antidepressant that blocks uptake of dopamine with less effect on norepinephrine

58
Q

What is the MOA of Mirtazapine?

A

Blocks presynaptic alpha-2 and serotonin-2 receptors to increase release of serotonin and norepinephrine

59
Q

What is the MOA of Bupropion?

A

Blocks uptake of dopamine
(less effect on norepinephrine)

60
Q

What effect does Mirtazapine have on norepinephrine?

A

Increases release

61
Q

What effect does Mirtazapine have on serotonin?

A

Increases release

62
Q

What effect does Bupropion have on dopamine?

A

Blocks uptake

63
Q

What effect does Bupropion have on norepinephrine?

A

Less effect

64
Q

Antidepressant that has little interaction with ethanol

65
Q

Antidepressant that has a high incidence of seizures, especially in patients with bulimia or when dose exceeds 450 mg/day

66
Q

Bupropion has a high incidence of seizures, especially in patients with this condition

67
Q

Bupropion has a high incidence of seizures, especially when dose exceeds this

A

450 mg/day

68
Q

Incidence of psychosis has been noted with this antidepressant
Also may be stimulating (so should be given early evening)

69
Q

Trazodone is this type of drug

A

Heterocyclic antidepressant

70
Q

Nefazodone is this type of drug

A

Heterocyclic antidepressant

71
Q

Heterocyclic antidepressants block this receptor

A

Presynaptic serotonin receptors
(to promote release)

72
Q

What effect do Heterocyclic antidepressants have on serotonin?

A

Promote release

73
Q

Heterocyclic antidepressant with hepatotoxicity

A

Nefazodone

74
Q

Heterocyclic antidepressant with side effect of persistent erection (pripism) in men and women

75
Q

What is the primary action of Vortioxetine?

A

Serotonin reuptake inhibitor

76
Q

Vortioxetine is an agonist of this receptor

77
Q

Vortioxetine is an antagonist of these two receptors

A

5-HT3 and 5-HT7

78
Q

Drug that is a serotonin reuptake inhibitor (primary action), 5-HT1a agonist, and 5-HT3 and 5-HT7 antagonist

A

Vortioxetine

79
Q

Primary adverse effects of this non-pharmacological therapy for depression are confusion, memory loss and delirium

A

ECT (electroconvulsive therapy)

80
Q

SSRI with a long lasting metabolite

A

Fluoxetine

81
Q

Side effects of this class of antidepressants includes GI disturbance, sexual dysfunction, anxiety rebound
Risk of withdrawal and serotonin syndrome

82
Q

Side effects of this class of antidepressants include increase in BP, risk of cardiac arrhythmias, severe withdrawal potential

83
Q

Side effects of this antidepressant include high level of sedation and marked stimulation of appetite

A

Mirtazapine

84
Q

What effect does Mirtazapine have on appetite?

85
Q

This antidepressant has low incidence of sexual side effects, and is mildly stimulating (amphetamine like mechanism)

86
Q

Antidepressant that has some risk of psychosis with long term use

87
Q

Class of antidepressants with MOA presumed to be related to blockade of norepinephrine uptake processes

A

Tricyclic antidepressants

88
Q

The MOA of Tricyclic antidepressants is presumed to be related to blockade of this process

A

Norepinephrine uptake

89
Q

Protein binding of this class of antidepressants is very sensitive to changes in pH

A

Tricyclic antidepressants

90
Q

Class of antidepressants with antimuscarinic effects and alpha-1 blockade effects

A

Tricyclic antidepressants

91
Q

Class of antidepressants that is a direct cardiac depressant
Arrhythmias and QT prolongation

A

Tricyclic antidepressants

92
Q

Class of antidepressants with side effects of toxic delirium, seizures, and weight gain

A

Tricyclic antidepressants

93
Q

If acidosis occurs, protein binding of this class of antidepressants decreases

A

Tricyclic antidepressants

94
Q

With Tricyclic antidepressants, if acidosis occurs, does protein binding increase or decrease?

95
Q

In Tricyclic antidepressants overdose, acidosis may occur, resulting in decreased protein binding. This should be treated with alkalization, with these two things:

A

Hyperventilation
Sodium bicarbonate

96
Q

Class of antidepressants that interacts with central nervous depressants, sympathetic agents, MAOIs, and anticholinergics

A

Tricyclic antidepressants

97
Q

Imipramine is this type of drug

A

Tricyclic antidepressants

98
Q

Maprotiline is this type of drug

A

Tricyclic antidepressant

99
Q

Clomipramine is this type of drug

A

Tricyclic antidepressant

100
Q

Amitriptyline is this type of drug

A

Tricyclic antidepressant

101
Q

Doxepin is this type of drug

A

Tricyclic antidepressant

102
Q

Long-term treatment of depression, enuresis of childhood, and pain management are indications for this class of antidepressants

A

Tricyclic antidepressants

103
Q

Therapeutic blood monitoring should occur with this class of antidepressants because of narrow range between effective and toxic doses

A

Tricyclic antidepressants

104
Q

Class of antidepressants generally used only for patients not responding to other safer therapies and should be prescribed by a specialist mental health professional

A

Monoamine oxidase inhibitors

105
Q

Isocarboxazid is this type of drug

A

Monoamine oxidase inhibitor
(irreversible)

106
Q

Phenelzine sulfate is this type of drug

A

Monoamine oxidase inhibitor
(irreversible)

107
Q

Tranylcypromine is this type of drug

A

Monoamine oxidase inhibitor
(irreversible)

108
Q

Monoamine oxidase inhibitor that has direct receptor agonist actions

A

Tranylcypromine

109
Q

Drug that is an irreversible inhibitor of MAO-B

A

Selegiline

110
Q

Selegiline is an irreversible inhibitor of this

111
Q

Common adverse effects of this class of antidepressants include tremors, sexual dysfunction, and orthostatic hypotension

A

Monoamine oxidase inhibitors

112
Q

Does orthostatic hypo- or hyper-tension occur with Monoamine oxidase inhibitors?

A

Hypotension

113
Q

This drug is a near absolute contraindication of Monoamine oxidase inhibitors due to risk of malignant hyperthermia

A

Meperidine

114
Q

Meperidine is a near absolute contraindication of this class of antidepressants due to risk of malignant hyperthermia

A

Monoamine oxidase inhibitors

115
Q

Meperidine is a near absolute contraindication of Monoamine oxidase inhibitors due to risk of this

A

Malignant hyperthermia

116
Q

Class of antidepressants that interacts with any sympathetic agents, and can cause a hypertensive crisis

A

Monoamine oxidase inhibitors

117
Q

Class of antidepressants with antihistamine effects including sedation and weight gain

A

Tricyclic antidepressants

118
Q

In overdose of Tricyclic antidepressants, this should be monitored

119
Q

In overdose of this class of antidepressants, serum pH should be monitored

A

Tricyclic antidepressants

120
Q

NMDA receptor blocker that is approved for treatment-resistant depression

A

Esketamine

121
Q

Esketamine is a blocker of this receptor
(is approved for treatment-resistant depression)

122
Q

Does bipolar disorder occur more commonly in females or males?

A

Similar occurrences in males and females

123
Q

What is the age of onset of bipolar disorder?

124
Q

Does this describe Bipolar I or II:
One manic (as opposed to hypomanic episode) lasting 7 or more days
May or may not have a major depressive episode

125
Q

Does this describe Bipolar I or II:
Must have had a major depressive episode lasting at least 2 weeks and 1 hypomanic episode
Often initially misdiagnosed as MDD, as hypomania is rarely presenting symptom

A

Bipolar II

126
Q

This mood stabilizer can be used to treat bipolar disorder, and requires monitoring for therapeutic dose and kidney function
Associated with low thyroid function, joint pain, indigestion

127
Q

Is electroconvulsive therapy effective at treating the manic or depressive state of bipolar disorder?

Neuro - Week 4 (9 decks)

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