MDD Flashcards
What is MDD also known as?
Unipolar depression or just depression
What are the essential criteria for diagnosing MDD?
At least five symptoms almost every day for at least 2 weeks, including a depressed mood or anhedonia
List additional symptoms that may indicate MDD.
- Sleep disturbances
- Changes in weight or appetite
- Decreased energy
- Feelings of guilt or worthlessness
- Psychomotor retardation or agitation
- Decreased concentration
- Suicidal ideation
What is persistent depressive disorder (dysthymia)?
Chronic depressed mood occurring more days than not for at least 2 years, not meeting MDD criteria
What are the components of patient assessment for depression?
- Psychiatric history
- Clinician rating scales
- Patient rating scales
- Physical examinations and lab tests
- Biologic testing
- Medication and substances
- Suicidal ideation
Name one clinician rating scale used for depression assessment.
Hamilton Rating Scale for Depression (HAM-D/HDRS)
What is the definition of remission in depression treatment?
Return to normal mood (e.g., HAM-D of 7 or less; PHQ-9 less than 5)
What is the recommended duration for treatment after achieving remission?
At least another 6–9 months
What is the goal of the acute treatment phase in depression therapy?
Remission
What is the typical onset time for antidepressant effects on physical symptoms?
Physical symptoms improve before affective symptoms
True or False: Antidepressants are considered equally efficacious.
True
What should be monitored during therapy for depression?
Response through interviews or repeating rating scales, and monitoring for adverse effects
What is the risk associated with all antidepressants in young adults?
Increased risk of suicidal thinking and behaviors
What is serotonin syndrome?
A potentially life-threatening condition caused by excessive serotonergic activity
What are common symptoms of serotonin syndrome?
- Neuromuscular hyperactivity
- Altered mental status
- Autonomic instability
What is the primary mechanism of action for bupropion?
Inhibition of dopamine and norepinephrine reuptake
Fill in the blank: The usual induction cycle for Electroconvulsive Therapy (ECT) is ______ treatments per week for 6–12 treatments.
Two or three
List some non-pharmacologic treatment options for depression.
- Interpersonal psychotherapy
- Cognitive Behavioral Therapy (CBT)
What is the black box warning for esketamine?
Sedation, dissociation, abuse and misuse, and suicidal thoughts and behaviors
What is the role of ketamine in depression treatment?
Used off-label for depression and suicidality in non-responsive patients
What is the common adverse reaction associated with esketamine?
Increased blood pressure
What should be done if a patient has a partial response to antidepressant treatment?
Ensure adherence and consider changing to a new antidepressant or adding adjunctive therapy
What is the typical duration for an adequate trial of antidepressants?
4–8 weeks
What are the side effects associated with SSRIs?
- GI symptoms
- Restlessness
- Insomnia
- Sexual dysfunction
- Headache
What is a common side effect of mirtazapine?
Increased appetite and weight gain
What is the primary use of trazodone in depression treatment?
Often used for insomnia at lower doses than for depression
What is the main concern with combining antidepressants?
Potential serotonin syndrome with at-risk agents
What is the mechanism of action for SNRIs?
Inhibition of serotonin and norepinephrine reuptake
What should be monitored after administering esketamine?
Mental status and blood pressure for at least 2 hours
What is the effect of paroxetine and fluvoxamine as SSRIs?
They are the most sedating
What is one of the withdrawal symptoms associated with TCAs?
Lacrimation
What is the FDA-approved combination for treatment-resistant depression?
Olanzapine plus fluoxetine
What are common side effects of Bupropion?
Anxiety, irritability, headache, decreased appetite
Bupropion may also increase energy and cause psychosis in susceptible individuals.
What potential benefit does Bupropion have regarding sexual function?
It may improve sexual function
This is an important consideration for patients concerned about sexual side effects from other antidepressants.
What are Tricyclic Antidepressants (TCAs) primarily limited by?
Adverse effects
Despite their effectiveness, TCAs are not commonly used due to the side effects.
What can TCA serum concentrations indicate?
Adherence or toxicity
However, this practice is infrequent in clinical settings.
What syndrome can occur with rapid discontinuation of TCAs?
Withdrawal syndrome
Symptoms include lacrimation, nausea, diarrhea, insomnia, restlessness, and possible balance problems.
How can withdrawal symptoms from TCAs be minimized?
Gradual dose reductions
This approach helps to mitigate the withdrawal syndrome.
Name three nonselective MAOIs.
- Isocarboxazid
- Phenelzine
- Tranylcypromine
These medications require careful monitoring due to dietary and drug interaction issues.
What must patients taking MAOIs avoid?
Foods high in tyramine
Tyramine can cause dangerous increases in blood pressure when consumed with MAOIs.
What types of drug interactions are significant with MAOIs?
- Over-the-counter decongestants
- Antidepressants
- Stimulants
- Antihypertensives
These interactions can lead to serious adverse effects.
How long should one wait before initiating an MAOI after discontinuing another antidepressant?
2 weeks
For fluoxetine, the waiting period should be 5–6 weeks; for vortioxetine, it’s 3 weeks.
What is the washout period when switching from an MAOI to another antidepressant?
2 weeks
This period helps to prevent serotonin toxicity.
