Module 4: Depression

Question 1

First line treatment for depression

Answer 1

SSRIs

Question 2

How to diagnose MDD

Answer 2

R/o medical causes first
R/o medication effect

Has to include either:
1.depressed mood
2. Loss of interest

PLUS
-weight/appetite changes
-sleep disturbances
-psychomotor retardation
-fatigue
-guilt/worthlessness
-diminished ability to concentrate
-SI

(5 total)

Question 3

Serotonin

Answer 3

Neurotransmitter helps reduce:
suicidality
eating behaviors
obsessive compulsive habits
anxiety
pain

Question 4

Norepinephrine

Answer 4

Neurotransmitter that produces alertness/energy
(Helps with anxiety and pain same as serotonin)
can help with attention similar to dopamine

Question 5

Dopamine

Answer 5

Neurotransmitter that helps with
motiviation
pleasure/reward
attention

Question 6

Non-pharmacological therapy

Answer 6

1 EXERCISE

#2: Psychotherapy for mild-moderate depression without psychosis

Question 7

Classes of antidepressants

Answer 7

1. SSRI
2. SNRI
3. NDRI
4. TCA
5. MAOIs
6. SRI/partial agonists

Question 8

SSRI list

Answer 8

Fluoxetine (prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram
Escitalopram

Question 9

SNRI list

Answer 9

Venlafaxine (effexor)
Duloxetine
Desvenlafaxine

Question 10

NDRI list

Answer 10

norepinephrine-dopamine re-uptake inhibitor

Wellbutrin
Dexmethylphenidate (Focalin)

Question 11

TCA list

Answer 11

Tricyclic antidepressant

Amitriptiline
Doxepin

Question 12

MAOIs

Answer 12

Monoamine oxidase inhibitors

Isocarboxazid, phenelzine, selegiline, and tranylcypromine

Question 13

Adverse effects of SSRIs

Answer 13

Early: Jitteriness, anxiety, nausea, diarrhea

Maintenance: Nausea, diarrhea, dizziness, anxiety, insomnia, sexual dysfunction, agitation, tremors, HA, Sedation

Less common: Bleeding, hyponatremia, SI

Question 14

SRI withdrawal syndrome

Answer 14

CNS: Irritable, depressed hallucination, bizarre dreams, dizziness

Neuromuscular: Muscle weakness, altered sensations (tingling, pricking, electric shocks)

Noradrenergic: Nausea, sweating, HTN

Question 15

Fluoxetine

Answer 15

Prozac – SSRI
VERY long half life, takes 5+ weeks to clear

VERY helpful in: MDD with fatigue/binge eating

Less helpful with: MDD w/ agitation, anxiety, anorexia, insomnia

“The flu: keeps you awake but not hungry”

Question 16

Sertraline

Answer 16

Zoloft. SSRI
Milder withdraw s/s than other SSRIs
Very helpful for MDD w fatigue, lactation

Less helpful for MDD with insomnia, IBS

Question 17

Paroxetine

Answer 17

Paxil. SSRI

*Mild anti-muscarinic (causes dry mouth, dry skin, flushing, palpitations)
(Blocks cholinergic receptors)

LARGE amount of withdrawal reactions

Good for MDD w/ anxiety or insomnia

Not good for MDD w/ fatigue, slowed motor movement
(Calming/sedating effects)

Question 18

Citalopram

Answer 18

Celexa. SSRI

*Use caution with H2 inhibitors and hepatic dysfunction

GOOD for geriatric population!!

NOT good for prolonged QTc…

Question 19

Escitalopram

Answer 19

Lexipro. SSRI

Less cardiotoxic

GOOD for patients with poly pharmacy (less drug interactions)

Question 20

SSRI and prolonged QTc

Answer 20

CITALOPRAM=worse

Sertraline/paroxetine=best

Question 21

SNRIs work best for MDD with decreased:

Answer 21

Energy, motivation, interest (think norepinephrine effects)

Question 22

Venlafaxine

Answer 22

Effexor. SNRI

Good for pts with MDD and psychomotor retardation/anxiety/pain

Not goood for pts twitch nausea, HTN, QTc prolongation

Question 23

Duloxetine

Answer 23

Cymbalta
Good for MDD w/ pain, urinary stress incontinence, anxiety

Less good for Nausea, BPH

NOT for pts with kidney failure

Question 24

Antidepressants and quality of life

Answer 24

Depression is the leading cause of disability worldwide
Health-related Quality of Life survey (HRQol)