Ott Depression Flashcards by joelle wasikowski

risk of reoccurrence with 1 episode
2 episodes
3 episodes

50-60%
70%
90%

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risk of recurrence over time

decreases as the duration of remission increases
(longer time in remission = decreased risk)

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predictor of recurrence?

persistent mild symptoms during remission

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at least one sx must be what for depression dx?

depressed mood or loss of interest/pleasure in doing things

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depression diagnostic mnemonic

SIGE CAPS
sleep
interest decreased
guilt / worthlessness
energy loss

concentration
appetite changes
psychomotor agitation
suicidal

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what rating scale screens for depression?

PHQ-9

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which rating scale is used to rule out bipolar?

MDQ (mood disorder questionaire)

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4 goals of depression treatment

reduce / eliminate signs
restore functioning to baseline
reduce risk of relapse
reduce risk of suicide

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Box warning for antidepressants

suicidal ideation in all pts 24 or younger
(counsel them all)

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which med has QTC prolongation?

citalopram

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citalopram substrate

2C19 and 3A4

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fluoxetine CYPs

2D6 inhibitor
3A4 inhibitor (norfluoxetine) (active metabolite)

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which drug has activating potential?

fluoxetine
take in morning

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which SSRI is the longest acting?

fluoxetine (96-144 hours)

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fluvoxamine CYPs

inhibitor 1A2
inhibitor 2C19

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paroxetine CYPs

inhibitor 2D6
inhibitor 2B6

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which SSRi is the hardest to stop?

paroxetine, anticholinergic effects

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paroxetine side effects

weight gain, sedation (take at night)

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which drug has septal wall defect risk

paroxetine

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sertraline side effect

more GI / nausea effect than others

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which SSRI is weight gain

paroxetine

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which SSRI is weight loss

fluoxetine

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adverse effects of SSRIs

sexual dysfunction
hyponatremia (in elderly)
increased bleeding risk (platelet inhibition)

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active metabolite of venlafaxine

desvenlafaxine

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desvenlafaxine CYPS

none :)

side effect of desvenlafaxine

nasua: dose limiting

which drug has FDA warning for hepatotoxicity

duloxetine

duloxetine CYP

inhibitor 2D6

levomilnacipran CYP

substrate 3A4

which drug must we adjust in renal impairment or strong 3A4

levomilnacipran

venlafaxine CYPs

2D6 inhibitor at high doses

venlafaxine dosing considerations

must be >150 mg for NE effects (pretty serotonin selective)

SNRIs useful in what disease states

pain syndrome musculoskeletal pain fibromyalgia neuropathic pain

duloxetine considerations

obtain LFTs at baseline and when symptomatic or every 6 months

SNRIs adverse effects

increased BP nausea

amitriptyline is a ____ amine

tertiary

amitriptyline use

lower doses for neuropathic pain

TCA CNS side effects

CNS: sedation, reduced seizure threshold, confusion

TCA anticholinergic side effects

blurry vision urinary retention constipation

TCA CV effects

orthostatic hypotension tachycardia

TCA other side effects

weight gain sexual dysfunction

TCA risk

doses as low as 1000 mg (4-10 tabs) - arrhythmia or seizure

washout period with MAOs

2 week washout before switching 3 week with fluoxetine

requirement of MAOs and exception

tyramine diet (except selegiline 6 mg patch)

caution with MAOs

hypertensive crisis serotonin syndrome

bupropion MOA

dopamine and NE reuptake inhibitor

buproprion stimulates what

insomnia appetite supression

which form of bupropion is used

buproprion CYP

inhibitor 2D6

buproprion contraindications

seizure disorder eating disorder

can we use bupropion with SSRIs/SNRIs?

yes

mirtazapine warnings

agranulocytosis increased cholesterol

can mirtazapine be used with SSRI/SNRI

yes

what occurs with mirtazapine lower doses?

<15 mg / day = sedation and increased appetite

what doses needed for trazodone in depression

higher doses

side effects trazodone

orthostatic hypotension priapism (EMERGENCY)

vilazodone MOA

SSRI with some 5HT1 agonism (anxiolytic effects)

can we use vilazodone with SSRI/SNRI?

vilazodone tips

take with food bioavailability better with food nausea without food

vilazodone CYP

substrate 3A4

vortioxetine MOA

SSRI + 5HT1A agonist + 5HT3 antagonist

can we use vortioxetine with SSRI/SNRI?

vortioxetine pearl

less sexual dysfunction NAUSEA

vortiozetine CYP

substrate 2D6

serotonin syndrome is a ______

medical emergency

serotonin blocker in serotonin syndrome

cyproheptadine

what can happen with all antidepressants except fluoxetine

withdrawal syndrome

antidepressants with ____ should be tapered immediately

anticholinergic activity

FDA approved augmentation agents

Atypical Antipsychotics aripiprazole brexiprazole cariprazine quetiapine

increase in what during first few weeks of therapy

suicidal thinking