MOOD 10

Question 1

TCAs can be secondary or tertiary amines…What are the two most common secondary and four most common tertiary TCAs?

Generally which TCAs class is “cleaner” with less SE?

Answer 1

Secondary TCA:

• NTP
• Desipramine

Tertiary TCA:

• Imipramine
• Amitriptyline
• Clomipramine
• Doxepin

Secondary TCAs have less SE

Question 2

Are there any absolute contraindications to ECT?

Answer 2

NO

Question 3

What are the 6 Relative Contraindications to ECT?

Answer 3

Cardio:

1. Recent MI
2. Decompensated CHF
3. Severe valvular disease
4. aneurysms or vascular malformation

CNS:

5. Increased ICP
6. Recent Stroke

PULM:
7. severe COPD or pneumonia

Question 4

Bright light therapy is indicated for SAD and for abbreviate sleep wake cycles…

how long should you do treatment?

How many LUX?

Answer 4

20-30 min in the morning

10,000 lux

Question 5

Vagus Nerve stimulation is a treatment modality approved as ADJUNCTIVE treatment for treatment refractory depression….how many failed med trials do you need to qualify?

How does it work?

Answer 5

4 medication trials.

LEFT vagus N is electrically stimulated (30 seconds on, 5 min off) which causes L vagus to activate bilateral Serotonin and NE discharge in the brain.

Question 6

In general SSRI’s are NOT associated with increased risk of congenital birth defects. Except which SSRI which is associated with possible increased risk of cardiac defects and thus is category D?

Answer 6

Paroxetine.

Question 7

Though SSRI’s are not associated with increased risk of congenital defects (except Paxil/heart defect) what illness is the baby at increased risk for?

Answer 7

Persistent Pulmonary HTN of new born (PPHN)

Question 8

Explosure to ANY SSRI after what how many weeks gestation is associated with how many fold increase in Persistent Pulmonary HTN of the Newborn?

Answer 8

SSRI exposure after 20 weeks is associated with 5X increased in PPHN.

Question 9

What are the known risk of SSRI us during pregnancy?

Answer 9

1. IF exposed after 20 weeks gestation, 5X increase in PPHN.
2. Preterm birth (but untreated MDD have higher rates)
3. Low birth weight and low apgar scores/respiratory distress.
4. Neonatal abstinence syndrome

Question 10

SSRIs are transmitted through breast milk…which SSRI has the lowest transmission rate?

Answer 10

Sertraline