Psych Flashcards
primary biogenic amine hypothesis of MDD
biogenic amine hypothesis which states deficit of norepinephrine, dopamine, or serotonin at the synapse= depression
receptor hypothesis of MDD
suggests depression is r/t up-regulation of monoamine neurotransmitter receptors in response to depletion of monoamine neurotransmitters
therefore antidepressants alter receptor sensitivity= desensitization or downregulation of monoamine neuro receptors = therapeutic response
what’s required for dx for major depressive episode and depression
episode: 5 sx x2 weeks that cause significant distress/impairment
- depressed mood, diminished interest/pleasure ADL decreased weight, appetite, sleep, increase/decrease psychomotor, fatigue, worthlessness/guilt, can’t think, SI
depression 1 or more MDEs during a lifetime
one extremely important tx goal of MDD
prevent suicide and suicide attempts
when is electroconvulsive therapy (ECT) indicated
MDD that’s complicated with psychotic features, severe suicidality, refusal to eat, pregnancy, or contraindication/non-response to pharmacotherapy
SE of ECT
temp. confusion and retrograde and anterograde amnesia
vagus nerve stim & SE
treatment-resistant depression
pulse generator surgically implanted around vagal nerve sends signals to brain to relieve sx
SE altered voice, hoarseness, dyspnea, neck pain
transcranial magnetic stimulation
non-invasive
approved after one failed trial of antidepressants
SE of SSRIs
sexual dysfunction, CNS stim (nervous, insomnia), nausea, diarrhea, weight gain, anhedonia fatigue
*nausea, anxiety, fatigue, HA usually transient
adjunct therapy with SSRI to improve sexual dysfunction
bupropion, cyproheptadine, sildenafil
SE and contraindications bupropion
insomnia, nightmares, decreased appetite, anxiety, tremors, SEIZURES*
contraindicated: seizure disorder, head trauma, anorexia, bulimia
Common SNRI SE
similar to SSRI
venlafaxine & desvenlafaxine = nausea (give w/ food, lower starting dose). High BP- monitor
duloxetine > hepatic injury so contraindicated heavy alcohol use or liver disease
mirtazapine/Remron SE
sedation & weight gain
serotonergic but RARELY causes serotonin-related effects like sexual dysfunction
2 antidepressants that need to go through REMS program
Esketamine d/t sedative and dissociative effects
Brexanolone d/t sedation and sudden LOC
SE of TCAs
sedative, anticholinergic, cardiovascular
Toxic at overdose at just less than 1 month supply
antidepressant with one of the longest half lives
fluoxetine (4-6 days)
requires 5 week washout before starting MAOI
how long of washout sufficient for serotonergic agents before MAOI
fluoxetine= 5 weeks d/t long half life
others= 2 weeks
most concerning pharmacodynamic interactions with antidepressants
hypertensive crisis and serotonin syndrome
what can cause hypertensive crisis
MAOI therapy and:
meds= ephedrine, pseudoephedrine, phenylephrine, stimulants
foods high in tyramine= aged cheese, beer, dry sausage, tofu
serotonin syndrome (hunter serotonin toxicity criteria)
- spontaneous clonus OR
- inducible clonus w/ agitation or diaphoresis OR
- ocular clonus w/ agitation or diaphoresis OR
- tremor and hyperreflexia OR
- hypertonia, temp > 100.4, ocular or inducible clonus
starting dose for most SSRI, desvenlafaxine, duloxetine, mirtazapine
often therapeutic dosage
efficacy of paharmacotherapy for MDD
each med 50%-75% response rate
no med or class more efficacious than another
*first line tx mild-severe depression
SSRI, SNRI, bupropion, or mirtazapine
mild may be managed with psychotherapy alone
most reliable predictor of response to antidepressants
pt hx of response
second best- first-degree relative’s response
