MDD Flashcards by Mohamed Ali

What is MDD also known as?

Unipolar depression or just depression

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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

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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

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What is persistent depressive disorder (dysthymia)?

Chronic depressed mood occurring more days than not for at least 2 years, not meeting MDD criteria

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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

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Name one clinician rating scale used for depression assessment.

Hamilton Rating Scale for Depression (HAM-D/HDRS)

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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)

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What is the recommended duration for treatment after achieving remission?

At least another 6–9 months

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What is the goal of the acute treatment phase in depression therapy?

Remission

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What is the typical onset time for antidepressant effects on physical symptoms?

Physical symptoms improve before affective symptoms

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True or False: Antidepressants are considered equally efficacious.

True

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What should be monitored during therapy for depression?

Response through interviews or repeating rating scales, and monitoring for adverse effects

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What is the risk associated with all antidepressants in young adults?

Increased risk of suicidal thinking and behaviors

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What is serotonin syndrome?

A potentially life-threatening condition caused by excessive serotonergic activity

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What are common symptoms of serotonin syndrome?

Neuromuscular hyperactivity
Altered mental status
Autonomic instability

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What is the primary mechanism of action for bupropion?

Inhibition of dopamine and norepinephrine reuptake

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Fill in the blank: The usual induction cycle for Electroconvulsive Therapy (ECT) is ______ treatments per week for 6–12 treatments.

Two or three

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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 ## Footnote 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 ## Footnote 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 ## Footnote Despite their effectiveness, TCAs are not commonly used due to the side effects.

What can TCA serum concentrations indicate?

Adherence or toxicity ## Footnote However, this practice is infrequent in clinical settings.

What syndrome can occur with rapid discontinuation of TCAs?

Withdrawal syndrome ## Footnote Symptoms include lacrimation, nausea, diarrhea, insomnia, restlessness, and possible balance problems.

How can withdrawal symptoms from TCAs be minimized?

Gradual dose reductions ## Footnote This approach helps to mitigate the withdrawal syndrome.

Name three nonselective MAOIs.

* Isocarboxazid * Phenelzine * Tranylcypromine ## Footnote These medications require careful monitoring due to dietary and drug interaction issues.

What must patients taking MAOIs avoid?

Foods high in tyramine ## Footnote 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 ## Footnote These interactions can lead to serious adverse effects.

How long should one wait before initiating an MAOI after discontinuing another antidepressant?

2 weeks ## Footnote 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 ## Footnote This period helps to prevent serotonin toxicity.