MDD Flashcards
s/s of MDD
Sleep Interest Guilt Energy Concentration Appetite Psychomotor Activity Suicidal ideation
How long must symptoms be present for a major depressive episode
2 weeks
how many symptoms must be present for a major depressive episode
5+
List the specifiers for MDD
Melanchoic Atypical Psychotic Mixed Catatonia Seasonal Pattern Peripartum Onset Anxious distress
features of melancholic MDD
anhedonia lack of reactivity worse in AM insomnia with early morning awakening guilt psychomotor activity decreased appetite/weight loss
features of atypical MDD
hypersomnia increased appetitie/weight gain worse in PM rejection sensitivity leaden paralysis irritable anxiety
features of psychotic MDD
delusions and hallucinations
usually seen in elderly
treatment options for psychotic MDD
ECT
Antidepressant and antipsychotic
features of mixed MDD
3+ of the following: elevated mood inflated self esteem more talkative FOI/racing thoughts increase energy inrease in potentially painful acitivities
features of catatonic MDD
mutism
vegetative signs
echolalia
features of seasonal MDD
relationship between time of year and depression s/s
regular remissions
MDD appears when in peripartum onset
within 4 weeks of delivery
features of anxious distress
keyed up or tense restless difficulty concentrating because of worry fear of something awful might lose control
define full remission
symptoms gone < 2 months
define partial remission
no longer MDD but still some symptoms
define recovery
symptoms gone 2+ months
define relapse
return of symptoms within 2 months
define recurrence
return of symptoms after 2 months; new episode
length of treatment for first episode of MDD
remission of symptoms + 6-12 months
length of treatment for second episode of MDD
remission of symptoms + 2 years
What factors should be considered for hospitalization of MDD pts
suicide
physical health
support system
catatonia
Which antidepressants can be fatal if OD’d
MAOI
TCAs
amoxapine
maprotiline
which antidepressants are safest for OD potential
SSRI
SNRI
Buproprion
Secondary causes of depression
drugs drug abuse metabolic disorders neurologic disorders nutritional disorders
most common cause of secondary depression
hypothyroidism
which drugs cause secondary depression
reserpine beta blockers alpha-methyldopa levodopa estrogens corticosteroids cholinergics benzos barbituates ranitidine calcium channel blockers
Non pharm treatments for MDD
ECT TMS Light therapy Psychotherapy (CBT) Exercise herbals VNS Folic Acid
ECT
electroconvulsive therapy
ECT seizure lasts how long
25 seconds to under 2 minutes
indications for ECT
psychotic depression catatonic depression refractory depression acute mania pregnant with bipolar
AEs of ECT
memory loss
Contraidications for ECT
recent MI
brain lesions
TMS
transcranial magnetic stimulation
AEs of TMS
headache
lightheadedness
CBT
cogntive behavioral therapy
Herbal used for MDD
St. Johns Wort
St John’s wort active ingrediant
hypericum perforatum
st john’s wort dose
300 mg TID
how long until effect of st john’s wort is seen
4 weeks
AEs of st john’s wort
nausea
photosensitivity
fatigue
VNS
vagus nerve stimulation
who gets VNS
treatment resistant depression
Folic acid dose for MDD
15 mg with an SSRI
Citalopram brand name
celexa
escitalopram brand name
lexapro
fluoxetine brand name
prozac
fluvoxamine brand name
luvox
paroxetine brand name
paxil
sertraline brand name
zoloft
vilazodone brand name
viibryd
name the SSRIs
citalopram escitalopram fluoxetine fluvoxamine paroxetine sertraline vilazodone
name the SNRIs
desvenlafaxine
duloxetine
levomilnacipran
venlafaxine
desvenlafaxine brand name
pristiq
duloxetine brand name
cymbalta
levomilnacipran brand name
fetzima
venlafaxine brand name
effexor
name the Triazolopyridines
nefazodone
trazodone
nefazodone brand name
serzone
trazodone brand name
desyrel
name an aminoketone used for MDD
buproprion
bupropion brand name
wellbutrin
TCAs for MDD
Amitriptyline Amoxapine Clomipramine Desipramine Doxepin Imipramine Maprotiline Nortiriptyline Protriptyline Trimipramine
Amitriptyline brand name
elavil
amoxapine brand name
ascendin
clomipramine brand name
anafranil
desipramine brand name
norpramin
doxepin brand name
sinequan
imipramine brand name
tofranil
maprotiline brand name
ludiomil
nortriptyline brand name
pamelor
protriptyline brand name
vivactil
trimipramine brand name
surmontil
Tetracycline used for MDD
mirtazapine
mirtazapine brand name
remeron
MAOIs used for MDD
selegiline
phenelzine
tranylcypromine
selegiline brand name
emsam
phenelzine brand name
nardil
tranylcypromine brand name
parnate
novel agent used for MDD
vortioxetine
vortioxetine brand name
brintellix
therapeutic dose range for amitriptyline
120-250 ng/ml
therapeutic dose range for desipramine
100-300 ng/ml
therapeutic dose range for tofranil
200-350 ng/ml
therapeutic dose range for nortriptyline
50-150 ng/ml
black box warning on all antidepressants
risk of suicide
factors to consider when choosing an antidepressant
past response familial response specifier/subtype side effects medical history drug-drug interactions cost
baseline monitoring for an SSRI
history PE TFTs CBC Chem 7 BP Pulse Weight Pregnancy test
citalopram pregnancy category
C
citalopram usual dosing
20 mg AM
citalopram doses > 40 mg QD risk
prolong QTC
elderly dosing for SSRIs
50% of normal dose
escitalopram usual dosing
10 mg AM
escitalopram pregnancy cat
C
Fluoxetine pregnancy cat
C
Which SSRI is most likely to cause jitteriness
fluoxetine
fluoxetine usual dose
20 mg AM
Fluvoxamine approved uses
OCD
fluvoamine dose
max 300 mg/day BID dosing start 50 mg HS
fluvoxamine preg cat
C
Paroxetine preg cat
D
Paroxetine usual dose
20 mg AM;
CR = 25 mg AM
Which SSRI most likely to cause sexual dysfunction and wieght gain
Paroxetine
SSRI most likely to cause nausea
Sertraline
Sertraline dosing
50-100 mg AM
sertraline preg cat
C
Vilazodone MOA
SSRI + 5HT1A partial agonist
Vilazodone dose
10 mg qd x 1 week, then 20 mg qd x 1 week, then 40 mg QD
vilazodone pregnancy cat
C
TCA drug interaction with SSRI
increase TCA concentration
lower TCA dose
Fluvoxamine and Vilazodone drug interaction with warfarin
increase warfarin levels
decrease dose, monitor INR/Ptt
SSRI interaction with MAOI
Serontonin synrome
AVOID
SSRI interaction with L-tryptophan
serontonin syndrome
AVOID
SSRI interaction with triptans
serotonin syndrome
AVOID
SSRI interaction with hypoglycemic agents
increased hypoglycemia
Monitor
SSRI interaction with type 1C antiarrhythmics
increase levels of antiarrhythmics
Caution
SSRI interaction with beta blockers
increased beta blockers
monitor heart rate and adjust
SSRI interaction with St John’s Wort
Serotonin syndrome
Stop SJW
Common AEs of SSRI
N/V diarrhea HA insomnia sexual dysfunction
SSRI discontinuation syndrome seen most often with what SSRIs
sertraline
paroxetine
Baseline labs for SSRIs
CBC chem 7 TFT BP Pulse Wt pregnancy test
labs for SSRIs at 2 weeks
Na+ levels
monthly monitoring for SSRIs
resolution of symptoms
Na+ level
Quarterly monitoring for SSRIs
resolution of symptoms
Na+
weight
Monitoring q6 months for SSRIs
electrolytes
Annual monitoring for SSRIs
CBC
chem 7
TFTs
which SSRI has an active metabolite
fluoxetine
how long are symptoms of SSRI discontinuation syndrome
3 days to 3 weeks
symptoms of SSRI discontinuation syndrome
nausea dizziness insomnia vivid dreams vertigo malaise headache
What to do before starting an SNRI
history physical CBC TFT Chem 7 BP pulse weight EKG Pregnancy test
max dose of venlafaxine IR
375 mg/day
dosing frequency of venlafaxine IR
BID-TID
dosing frequency of venlafaxine ER
QD
Rare AE of venlafaxine
HTN
Venlafaxine dosing must be what
titrated
Max dose of venlafaxine ER
225 mg
desvenlafaxine is the active metabolite of what
venlafaxine
desvenlafaxine dosing
50 mg QD
desvenlafaxine max
400 mg/day
venlafaxine drug interactions
MAOI Indinavir Triptans SJW Warfarin
venlafaxine should be avoided with what
MAOI
Indinavir
Triptans
SJW
Interaction between venlafaxine and MAOI
Serotonin syndrome/hypertensive crisis
interaction between venlafaxine and Indinavir
decreased indinavir
interaction between venlafaxine and Triptans
serotonin syndrom
interaction between venlafaxine and SJW
serotonin syndrome
interaction between venlafaxine and warfarin
increased Ptt, INR;
Monitor
Venlafaxine pregnancy cat
C
Venalfaxine AEs
HA insomnia drowsiness dizziness diaphoresiss weight loss nausea dry mouth anorexia sexual dysfunction weakness
desvenlafaxine preg cat
c
duloxetine dosing
20 mg BID up to 60 mg/day (30 mg BID or ^) qd)
duloxetine AEs
N/V
sexual dysfunction
HTN
duloxetine preg cat
c
duloxetine should be avoided with what medications
fluvoxamine quinolone antibiotics alcohol SSRI MAOI TCA triptans
duloxetine should be monitored with what drug
smoking
levomilnacipran preg cat
C
levomilnacipran dosing
40 mg dialy ma 120/day
AEs of levomilnacipran
N/V constipation sweating tachycardia HTN
levomilnacipran drug interactions to avoid
alochol
ketoconazole
NSAIDS
Warfarin
SNRI monitoring at baseline
CBC Chem 7 TFTs EKG BP pulse Weight Pregnancy
SNRI monitoring monthly
resolution of symptoms
BP
pulse
weight
SNRI monitoring annually
EKG CBC Chem 7 TFTs BP Pulse weight
SNRI indications
GAD MDD Panic SAD neuropathy fibromyalgia
nefazodone dosing
300-600 mg /day given BID
nefazodone AEs
dizziness blurred vision dry mouth constipation HA orthostasis LITTLE TO NO SEXUAL
black box warning of nefazodone
liver dysfunction
nefazodone preg cat
c
trazodone dosing
50 mg HS x 3 days up to 150 mg HS (max 600 mg/day)
AEs of trazodone
sedation dry mouth blurred vision mental dullness orthostasis RARE- PRIAPISM
trazodone preg cat
C
Trazodone drug interactions to be avoided
CNS depressants
MAOI
Nefazodone drug interactions to be avoided
general anesthetics
triptans
MAOI
Statins
Nefazodone drug interaction with buspirone
decrease buspirone dose to 2.5 mg BID
Baseline monitoring for Triazolopyridines
CBC Chem 7 TFT EKG BP Pulse weight Preg
Monthly monitoring of triazolopyridines
resolution of symptoms
BP
Pulse
Weight
Annual monitoring of triazolopyridines
EKG CBC Chem 7 TFT BP pulse Weight
baseline monitoring for bupropion
CBC Chem 7 TFTs EKG BP Pulse Weight Preg Test
Monthly monitoring for buproprion
resolution of symptoms
BP
pulse
weight
Annual monitoring for bupropion
EKG CBC Chem 7 TFT BP pulse weight
bupropion dose IR
100 mg BID x 3 days
100 mg TID
MAx 450/day
bupropion SR dose
150 mg x 5 days, then 150 mg BID
bupropion XL dose
150 mg x 5 days, then 300 mg qd
bupropion preg cat
C
bupropion AEs
HA Nausea tachycardia dizziness insomnia agitation weight loss dry mouth NO SEXUAL RARE- SEIZURE
avoid what drugs with bupropion
MAOI
Ritonavir
Drugs that lower seizure threshold
Bupropion drug interaction with beta blocker
decreased BP, HR
adjust dose of beta blocker
Bupropion drug interaction with SSRI
reduce dose of SSRI
Bupropion drug interaction with warfarin
monitor INR, increased bleeding
