review points Flashcards
What are the first-line treatments for mild-mod depression in pregnancy?
CBT (I)
IPT (I)
What are the second-line treatments for mild-mod depression in pregnancy?
Citalopram (III)
Escitalopram (III)
Sertraline (III)
[the same as during breastfeeding]
What are the third-line treatments for mild-mod depression in pregnancy?
(all drugs are level III or IV)
Fluoxetine
Fluvoxamine
Duloxetine
Venlafaxine
Desvenlafaxine
Bupropion
Mirtazapine
TCAs (not clomipramine)
ECT (III)
Exercise, acupuncture, bright-light (II) Other therapies (IV)
Combo SSRI + CBT/IPT (IV)
First line treatments in depression w/ breastfeeding
CBT or IPT (I)
Second line treatments in depression w/ breastfeeding
Citalopram (II)
Escitalopram (II)
Sertraline (II)
[the same as during pregnancy]
SSRI + CBT/IPT (II)
Third line treatments in depression w/ breastfeeding
Fluoxetine (II)
Fluvoxamine (II)
Paroxetine (II)
TCAs (not doxepin) (II)
Duloxetine (III)
Desvenlafaxine (III)
Venlafaxine (III)
Mirtazapine (III)
Bupropion (III)
ECT (III)
Other: therapies, bright light, exercise, acupuncture, behavioural activation
First line treatment for peri-menopausal depression
Desvenlafaxine (I)
CBT (II)
Second line treatment for peri-menopausal depression
transdermal estradiol (II)
citalopram (III)
escitalopram (III)
duloxetine (III)
venlafaxine (III)
mirtazapine (III)
quetiapine (III)
fluoxetine, sertraline, paroxetine, nortryptiline and Omega3 FAs (IV)
Third line treatment for peri-menopausal depression
mindfulness cbt, supportive
First line in LLD (CANMAT)
Duloxetine (I)
Mirtazapine (I)
Nortriptyline (I)
Citalopram (II)
Escitalopram (II)
Sertraline (II)
Duloxetine (II)
Desvenlafaxine (II)
Venlafaxine (II)
Voritoxetine (II)
Second line in LLD
Nortriptyline (I) Moclobemide (II) Phenelzine (II) Trazodone (II) Quetiapine (II) Bupropion (III)
Augmentation in LLD
Augmentation is considered second line:
Aripiprazole (I)
Lithium (I)
Methylphenidate (II)
In the CANMAT guidelines, which antidepressants have evidence for superior efficacy based on meta-analysis
Escitalopram
Citalopram
Sertraline
[same as meds for pregnancy and breastfeeding depression!]
Venlafaxine
Mirtazapine
Agomelatine
CANMAT first line ADs (15 tot) There are: - 6 SSRIs - 4 SNRIs - 5 other
Citalopram Escitalopram Fluoxetine Sertraline Paroxetine Fluvoxamine
Duloxetine
Desvenlafaxine
Venlafaxine
Milnacipran
Vortioxetine Mirtazapine Bupropion Agomelatine Milanserin
CANMAT first line adjuncts (3)
Aripiprazole (I)
Quetiapine (I)
Risperidone (I)
CANMAT second line adjuncts (7)
Brexipip (I)
Olanzapine (I)
Bupropion (II)
Mirtaz (II)
Lithium (II)
Modafinil (II)
T3 (II)
Varenicline MOA
Partial agonist at α4β2 nAChR
Bupropion MOA
Noradrenaline and dopamine reuptake inhibitor
Dose: 150-300 mg daily
Cyp 2D6 inhibitor
Which patients need long-term depression treatment?
Patients with:
- frequent, recurrent episodes
- severe episodes (psychosis, severe impairment, suicidality)
- chronic episodes
- presence of co-morbid psychiatric or other medical conditions
- presence of residual symptoms
- difficult-to-treat episodes
What are the risk factors for chronic or recurrent depressive episodes?
- Earlier age of onset
- Greater number of previous episodes
- Severity of the initial episode (defined by the presence of a greater number of symptoms, suicidal ideation, or psychomotor agitation)
- Disruptions of the sleep-wake cycle
- Presence of comorbid psychopathology (particularly persistent depressive disorder/dysthymia)
- Family history of psychiatric illness
- Presence of negative cognitions
- High neuroticism
- Poor social support
- Stressful life events
Indications for ECT
- acute SI (I)
- psychotic features (I)
- treatment-resistant depression (I)
- medication intolerance (III)
- catatonic features (III)
- prior response to ECT (III)
- rapidly deteriorating physical health (III)
- pregnancy for any of the above (III)
- patient preference (IV)
What are the first-line medication treatments for panic disorder?
(all the SSRIs and venlafaxine)
escitalopram, citalopram, fluoxetine, sertraline, paroxetine, fluvoxamine
Recall: CBT»pharmacoptherapy BUT CBT+pharmacotherapy is superior to either alone
What are the second-line medication treatments for panic disorder?
Clomipramine + imipramine
alprazolam, clonazepam, diazepam, lorazepam
mirtazapine
reboxetine
What are the second-line adjuncts for panic disorder?
2nd line: alprazolam, clonazepam
What medications are explicitly NOT recommended in panic disorder?
buspirone
trazodone
propranolol
tiagabine
What are the first-line medications for SAD?
escitalopram, sertraline, paroxetine, fluvoxamine
(NO citalopram or fluoxetine)
venlafaxine
pregabalin
Recall: CBT is considered first line for SAD and in most cases CBT is as effective as CBT+pharmacotherapy
What are the second-line medications for SAD?
citalopram
alprazolam, bromazepam, clonazepam
gabapentin
phenelzine
What are the adjuncts for SAD?
aripiprazole, risperidone
paroxetine
buspirone
What are the first-line medications for GAD?
escitalopram, paroxetine, sertraline
duloxetine, venlafaxine
pregabalin
agomelatine
Recall: CBT = pharmacotherapy, combination only recommended if one alone fails
What are the second-line medications for GAD?
alprazolam, bromazepam, diazepam, lorazepam vortioxetine bupropion buspirone quetiapine hydroxyzine
What are the adjuncts for GAD?
pregabalin
What are the first-line treatments for BPAD I depression?
quetiapine (I) lithium (II) lamotrigine (II) lurasidone (II) lamotrigine + any (II) lurasidone + li/val (I)
What are the second-line treatments for BPAD I depression?
cariprazine (I) valproic acid (II) adj SSRI/bupropion (I) olanzapine + fluoxetine (II) ECT (IV)
What are the first-line treatments for BPAD mania?
lithium epival asenapine +/- li/val aripiprazole +/- li/val risperidone +/- li/val quetiapine +/- li/val paliperidone cariprazine
- all level I evidence except asenapine and aripiprazole combos (level II)
What are the second-line treatments for BPAD mania?
lithium + epival olanzapine +/- li/val haldol ziprasidone carbamazepine ECT
What are the first-line treatments for BPAD I maintenance?
lithium (I) epival (I) lamotrigine (I) quetiapine (I) quetiapine + li/val (I) aripirazole +/- li/val (II) asenapine (II)
What are the second-line treatments for BPAD I maintenance?
olanzapine (I) risperidone LAI (I) risperidone LAI adj. (II) lurasidone + li/val (III) ziprasidone + li/val (II) carbamazepine (II) paliperidone (II)
What are the first-line treatments for BPAD II depression?
quetiapine (I)
What are the second-line treatments for BPAD II depression?
lithium (II) lamotrigine (II) venlafaxine (II) sertraline (II) bupropion adj (II) ECT (III)
What are the first-line treatments for BPAD II maintenance?
quetiapine (I)
lithium (II)
lamotrigine (II)
What are the second-line treatments for BPAD II maintenance?
venlafaxine (II)
CANMAT recommends lithium for BPAD when:
classic grandiose mania few prior episodes mania -> depression -> euthymia course family history of BPAD family history of lithium response
CANMAT recommends valproic acid for BPAD when:
dysphoric mania, predominant irritable/dysphoric mood
multiple prior episodes
comorbid substance abuse
history of head trauma
CANMAT recommendation for mixed-feature treatment:
atypical antipsychotics +/- divalproex, combination typically required.
specifically asenapine, aripiprazole, olanzapine and ziprasidone
CANMAT recommendation for BPAD w/ anxious distress:
quetiapine
olanzapine with lithium or fluoxetine
lurasidone with lithium
CANMAT recommendation for BPAD rapid cycling:
lithium divalproex olanzapine quetiapine NOT lamotrigine
Which mood stabilizers affect OCP levels?
carbamazepine
lamotrigine
topiramate
What is the effect of lamotrigine and OCP?
they reduce the efficacy of each other (CANMAT pg 131)
Preferred choice of meds in BPAD for breastfeeding as per CANMAT:
olanzapine
quetiapine
Risk factors for BPAD in pediatric depression:
family history (+) early age of onset (+) psychotic symptoms (+)
cyclothymia
emotional/behavioural dysregulation
subthreshold manic symptoms
atypical depression
First-line treatments for mania in children:
First line: lithium (I) risperidone (I) - consider with ADHD quetiapine (II) aripirazole (II) asenapine (II)
Second-line treatments for mania in children:
olanzapine (II) lurasidone (II) quetiapine adj (III)
First-line treatments for BPAD depression in children:
lurasidone (II)
Second-line treatments for BPAD depression in children:
lamotrigine (IV)
lithium (IV)
First-line treatments for BPAD maintenance in children:
lithium
epival
aripirazole
