Ott Depression Flashcards
risk of reoccurrence with 1 episode
2 episodes
3 episodes
50-60%
70%
90%
risk of recurrence over time
decreases as the duration of remission increases
(longer time in remission = decreased risk)
predictor of recurrence?
persistent mild symptoms during remission
at least one sx must be what for depression dx?
depressed mood or loss of interest/pleasure in doing things
depression diagnostic mnemonic
SIGE CAPS
sleep
interest decreased
guilt / worthlessness
energy loss
concentration
appetite changes
psychomotor agitation
suicidal
what rating scale screens for depression?
PHQ-9
which rating scale is used to rule out bipolar?
MDQ (mood disorder questionaire)
4 goals of depression treatment
reduce / eliminate signs
restore functioning to baseline
reduce risk of relapse
reduce risk of suicide
Box warning for antidepressants
suicidal ideation in all pts 24 or younger
(counsel them all)
which med has QTC prolongation?
citalopram
citalopram substrate
2C19 and 3A4
fluoxetine CYPs
2D6 inhibitor
3A4 inhibitor (norfluoxetine) (active metabolite)
which drug has activating potential?
fluoxetine
take in morning
which SSRI is the longest acting?
fluoxetine (96-144 hours)
fluvoxamine CYPs
inhibitor 1A2
inhibitor 2C19
paroxetine CYPs
inhibitor 2D6
inhibitor 2B6
which SSRi is the hardest to stop?
paroxetine, anticholinergic effects
paroxetine side effects
weight gain, sedation (take at night)
which drug has septal wall defect risk
paroxetine
sertraline side effect
more GI / nausea effect than others
which SSRI is weight gain
paroxetine
which SSRI is weight loss
fluoxetine
adverse effects of SSRIs
sexual dysfunction
hyponatremia (in elderly)
increased bleeding risk (platelet inhibition)
active metabolite of venlafaxine
desvenlafaxine
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
XL
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?
no
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?
no
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
