psych Flashcards
diff categories of tx for depression
Pharmacotherapy
Combination of Pharmacotherapy + Psychotherapy
Others: ECT, light therapy, vagus nerve stimulation, transcranial magnetic stimulation
SSRI agents
Fluoxetine Paroxetine Sertraline Citalopram Escitalopram
AE of SSRIs
GI, anxiety/nervousness, sexual dysfunction
AE of SNRIs
Mild to moderate insomnia, nausea, HA,
tremor, anxiety, dry mouth
Sexual dysfunction common
May ↑ BP; reports of HF worsening (class
effect)
TG & LDL reported with De
Substantial dose titration required (V)
Do not use in patients with ESRD or hepatic
insufficiency (Du)
SNRI agents
Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Levomilnacipran (Fetzima) [Milnacipran (Savella): only approved to treat fibromyalgia]
antidepressant not associated with weight gain or sexual dysfunction
buproprion (wellbutrin)
CI of buproprion
eating disorder or seizures and use of mAOI in last 14 days
CI of all antidepressants
use of MAOI in last 14 days
good antidepressant for someone also dealing with insomnia and/or needs to gain weight
noradrenergic and specific serotonergic antidepressant
AE of noradrengergic and specific serotonergic antidepressant Mirtazapine
High sedative and weight gain effects Mild to moderate anticholinergic effects and dizziness Associated with agranulocytosis and neutropenia
pros and cons of TCAs for depression
pros: once daily dosing, useful for other conditions (migraines, neuropathic pain)
cons: high degree of sedation and weight gain, dangerous in overdose, titration req’d
which antidepressant can cause priapism?
trazodone
1st line meds for depression
SSRIs, SNRIs, NDRIs (buproprion),
serotonin syndrome symtpoms
mental status change, agitation, myoclonus, hyperreflexia, fever, diaphoresis, ataxia, diarrhea. CAN PROGRESS TO hyperthermia, seizures, death
how do you avoid serotonin syndrome when switching agents?
taper off first agent, wait 5 half lives or a “wash out period” and then start next one
how do you avoid serotonin discontinuation period?
TAPER over 4 weeks
serotonin discontinuation sx:
Dizziness, nausea, fatigue most commonly seen; vomiting, agitation, insomnia, tremors,
myalgia less common
what is risk of GI bleed with SSRIs (and proprably SNRIs)?
3x risk if concurrently taking NSAIDs (for those already at risk of GI bleed)
which SSRI has shortest half life and thus a longer taper? what else should be known about it?
paroextine (paxil), btwn dose withdrawal in younger pts, avoid in younger pts
which SSRI has most drug intx?
fluvoxamine (luvox)
which SSRIs can prolong QT
citalopram and escitalopram
acute phase of depression tx lasts how long? (until sx abate?)
usu 6-12 weeks
important pt ed for antidepressants
AE may be felt right way, but therapeutic effects on mood may take 2-4 weeks to start and 6-8 wks to be at full effect
why does a suicide risk increase in the 1st 1-2 weeks after starting an antidepressant?
energy increase 1st before mood does.
adequate trial of antidepressant
adequate dose for at least 4 wks, 8 wks is preferable
how long should people be on antidepressants before you can discontinue it?
4-9 months if their 1st or 2nd episodEOF MDD
who should be on maintenance antidepressants?
multiple episodes, severe episodes, prior suicide attempts (esp those with comorbid psych conditions or chronic medical conditions)
who is at highest risk of suicice on antidepressants?
children, adolescents and young adults–balance with clinical need
trade names of SSRIs
fluoxetine prozac sertraline zoloft paroextine paxil citalopram celexa escitalopram lexapro
herbal therapy for depression
st. john’s wort
common drugs used to augment resistant antidepressant tx
lithium,levothyroxine, atypical antipsychotics
is psychotherapy rec’d for bipolar?
yes, or in combo with pharmacotherapy
common AE of lithium
thirst, polyuria, cognitive complaints, tremor, weight gain, sedation, diarrhea, nausea
(watch for dehydration, which can lead to toxicity), hypothyroidism, transient leukocytosis.
T or F: drugs for bipolar have a therapeutic range
T
T or F: Lithium can abort a manic episode
T: it takes about 1-2 weeks
T or F: Lithium is not effective at preventing gsuicide
F: it may help decrease risk of suicide and suicide attempts
1st line mood stabilizers for bipolar disorder
lithium, valproic acid, carbamazepine, lamotrigine
AE of valproic acid
tremor, sedation, diarrhea, nausea, weight gain, hair loss, LFT elevations, thrombocytopenia
drugs for bipolar to avoid in pregnancy
valproic acid, carbamazepine
carbamazepine AE
headache, nystagmus, ataxia, sedation, nausea, cognitive complaints, rash, leukopenia, mild
LFT elevations
type of patient with bipolar that lamotrigine may be best for
those who are currently presenting with a depressive episode
T or F: lamotrigine should be titrated
T to prevent a rash
tx for patients w/ bipolar who are unresponsive to meds
ECT
tx of mild to moderate depressive episodes in bipolar
Lithium or lamotrigine 1st (reserve antidepressants for those with severe depression)
maintenance tx for bipolar
lithium or VPA
