Managment Of Depressive Mood Disorders

Question 1

What percent of the US population has had a lifetime prevalence of MDD episode?

Answer 1

17.1% (not sure this matters but whatever)

Question 2

Diagnostic criteria for MDD:

Must have 5 of 9 symptoms to include either _______ ______ or _______ ______ ______, plus 4 more from SIGECAPS.

Answer 2

Depressed mood

Loss of interest/pleasure

Question 3

What is SIGECAPS?

Answer 3

Sleep (+/-)
Interest (-)
Guilt
Energy (-)
Concentration (-)
Appetite (+/-)
Psychomotor sx
Suicidality

Question 4

What two variations of SIGECAPS is present with atypical depression?

Answer 4

Excessive appetite

Excessive sleep

Question 5

If a patient has 2-4 of the 9 symptoms listed above for at least 2 weeks, and one of the symptoms is either depressed mood or loss of interest, this patient has?

Answer 5

Minor depression (major is 5/9)

Question 6

Screening for depression in primary care. USPSTF recommends screening for depression in practices that can effectively manage such patients. They recommend a two question depression screen:
1) over the past 2 wks have you felt down or hopeless?
2) over the past 2 wks have you felt little interest in doing things?
A “yes” to either question is a positive indication for what?

Answer 6

Depression

Question 7

What percent of patients with 1st depressive episode will have a 2nd?

Answer 7

50%

Question 8

A second episode of depression increases the risk to what percent of having a third?

Answer 8

70-80%

Question 9

Major depression with an emphasis on lack of pleasure or lack of reactivity to pleasure is what kind of depression?

Answer 9

Melancholic

Question 10

For melancholic depression with lack of pleasure, you must have how many of the folowing 5:
Depressed mood worst in the morning
Early morning awakening
Psychomotor agitation or retardation
Significant weight loss
Inappropriate guilt

Answer 10

3 or more

Question 11

If MDD must be present for at least 2 weeks, how long must persistent depressive disorder PDD (dysthymia) be present for a diagnosis?

Answer 11

At least 2 years

Question 12

What depression is listed below?
Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years?

Answer 12

PDD (persistent)

Question 13

What disorder is when a patient has PDD and MDD?

Answer 13

Double depression

More substantial level of social impairment

Question 14

To diagnose PDD, the patient must have never been without the symptoms in a 2 year period for more than how many months?

Answer 14

2 months

Question 15

Factors to consider in selecting an antidepressant:
Those who received a preferred treatment experienced (more/less) rapid improvements than those who received a therapy not matching their prefernce?

Answer 15

More

Question 16

What conditions are contraindications for Rx’ing TCA’s?

Answer 16

Ischemic heart disease
Fall risk
BPH (benign prostatic hyperplasia)
Suicidal ideation (pt can overdose)

Question 17

Is venlafaxine an SSRI or SNRI?

Answer 17

SNRI

Question 18

What is the brand name for the SNRI venlafaxine?

Answer 18

Effexor

Question 19

Is duloxetine an SSRI or SNRI?

Answer 19

SNRI

Question 20

What is the brand name of duloxetine?

Answer 20

Cymbalta

Question 21

What class of antidepressants are the following medications:
Sertraline (zoloft)
Citalopram (celexa)
Escitalopram (lexapro)
Fluoxetine (prozac)

Answer 21

SSRI (selective serotonin re-uptake inhibitor)

Question 22

Name two TCA meds.

Answer 22

Amitriptyline

Nortriptyline

Question 23

What antidepressant NDRI is the best treatment for someone wishing to quit smoking?

Answer 23

Bupropion (Wellbutrin)

Question 24

What antidepressant is most indicated for an older patient who has a BMI of 19?

Answer 24

Mirtazipine (Remeron)
Anti-nausea effect
Appetite stimulant

Question 25

MDD has a high chance of being accompanied by what comorbid disorder?

Answer 25

Anxiety

Question 26

Why do patients d/c their antidepressants?

Answer 26

Feeling better (55%)
Adverse events (23%)

Question 27

Common s/e of SSRI’s include nausea, nervousness, headache, etc. Name 2 more.

Answer 27

Insomnia

Sexual dysfunction

Question 28

What least activating SSRi is avoided during pregnancy?

Answer 28

Paroxetine “D” in pregnancy (Paxil)

Question 29

What SSRI is commonly given for OCD?

Answer 29

Clomipramine (Anafranil)

Question 30

What s/e of antidepressants does not go away, unlike anxiety and jitteriness?

Answer 30

Loss of libido

Question 31

What antidepressant could you add for a pt with insomnia?

Answer 31

Trazodone

Question 32

What can you take to combat the sexual s/e of antidepressants?

Answer 32

Yohimbine
Amantadine
Cyproheptadine
Buspirone
Bupropion (wellbutrin)
Dose-reduction
Skipped dose

Question 33

What sx would you see with serotonin syndrome?

Answer 33

Diarrhea
Fever
Agitation
Incoordination
Shivering
Hyperreflexia
Diaphoretic

Question 34

Describe sx for when patients discontinue SSRI’s, aka FLUSH

Answer 34

Flu-like sx
Light-headedness, dizziness
Uneasiness
Sleep disturbance
Headaches

Question 35

Depression with psychotic features present concurrent with MDD and show resistance to?

What does help with this disorder?

Answer 35

Standard tx of SSRI

ECT (electroconvulsive therapy)

Question 36

Is there a significant statistical risk of major malformations for pts who take an SSRI during pregnancy?

Answer 36

Nope

Question 37

Some antidepressant have an inhibitory effect on CYP450, which can effect the efficacy of other drugs. Name the two most prominent SSRI’s that have 2D6 substrates that cause this inhibitory effect.

Answer 37

Fluoxetine (Prozac) and Paroxetine (Paxil)

Both end in oxetine and the brand names begin with P