Mood

Question 1

Sleep changes in depression re

• rem sleep latency
• slow wave
• sleep latency

Answer 1

Decreased rem latency
Decreased slow wave (stage 3 and 4)
Increased sleep latency (harder to fall asleep)
Increased REM density (more REM)

Question 2

Recommendation for dep with cognitive dysfunction

Answer 2

Vortioxetine (level 1)
Bupropion (level 2)
Duloxetine (level 2)

Question 3

Recommendation for dep with sleep disturbance?

Answer 3

Agomelatine (level 1)
Mirtazapine (level 2)
Quetiapine (level 2)
Trazodone (level 2)

Question 4

Antidepressants with least sexual side effects as per Canmat

Answer 4

Agomelatine
Bupropion
Mirtazapine
Vilazodone
Vortioxetine

Question 5

Strongest inhibitors as per canmat

Answer 5

Fluoxetine (2D6)
Paroxetine (2D6)
Fluvoxamine (1A2, 2C19, 3A4)

Question 6

Sleep changes in manic/hypomanic episode

Answer 6

Decreased REM latency

Decreased delta

Question 7

3 things associated with rapid cycling as per canmat

Answer 7

Hypothyroidism
Antidepressants
Substance use

Question 8

Changes to metabolism of meds in pregnancy

Answer 8

Increased plasma volume
Increased hepatic activity
Increased rental clearance

Question 9

Sexual side effects, what to do?

Answer 9

• lower dose
• add Wellbutrin/viagra/amphetamine
• Add remeron
• or use moclobemide/Wellbutrin/remeron

Question 10

As per canmat alcohol and depression?

Answer 10

Remeron, naltrexone, naltrexone and Zoloft

Question 11

Things that increase and decrease seizure threshold

Answer 11

Increase:
Benzos, anticonvulsants, lidocaine
Barbs
Men, elderly
Treatments increase up to 200 % of seizure threshold

Decrease:
Li, CLZ
All antipsychotics
Wellbutrin
Caffeine, hyperventilation 
Theophylline 
L tryptophan

Question 12

Relative contraindications vs contraindications for rTMS

Answer 12

Absolute: metallic hardware in head except mouth

Relative: cardiac pacemaker, defibrillator, epilepsy history, brain lesion