Therapeutics of Depression Flashcards
what is the PHQ-9?
9 questions of the 9 symptoms of depression
how do you interpret a PHQ-9 score?
5 is mild
10 is moderate
20 is severe
what does GDS stand for?
geriatric depression scale
what does HAM-D stand for?
hamilton rating scale for depression
what does MADRS stand for?
montgomery-asberg depression rating scale
what does beck depression inventory measure?
behavioral symptoms
what is the diagnostic criteria for MDD? (D SIG E CAPS)
depression
sleep (increased or decreased)
decreased interest
guilt
decreased energy
decreased concentration
appetite (increased or decreased)
psychomotor changes (increased or decreased. ex. move slower with hands)
suicidality
how do you interpret the diagnostic criteria for MDD?
if patient has 5 of the symptoms listed within the same 2 week period (with one symptom being depressed mood or loss of interest) than they can be diagnosed with depression
what are 5 risk factors that lower recovery rates for depression?
-being male
-hopelessness
-adolescent/young adult
-childhood trauma
-physical illness
the longer the time between episodes the _____ the risk of recurrence
lower
T/F some people’s depression can go away without help
true
define dysthymia MDD
someone who does not have 5 symptoms of depression but meets the criteria for MDD for 2 or more years
what are other diagnoses that may mimic depression but should be ruled out before diagnosing for depression?
hypothyroidism
low testosterone
chronic diseases
anemia
how does chronic opioid use effect testosterone?
lowers testosterone
why can anemia show symptoms of depression?
causes low energy
should you ask depression patients if they have thoughts of suicide?
yes, you need to know if they have thoughts of hurting themselves, if they have considered suicide, and if they have made a plan to commit suicide
what is an example of passive suicide ideation?
swallowing pills to commit suicide
what is an example of active suicide ideation?
using a gun to commit suicide
T/F attempts to commit suicide increase with age and older patients are more likely to succeed with suicide
false, attempts to commit suicide decrease with age, but older patients are more likely to complete a suicide attempt
T/F men are more likely to attempt suicide but less likely to complete
false, women are
define non-response
less than 25% improvement
define partial response
26-49% improvement
define response
over 50% improvement
define remission
no symptoms
define treatment resistant depression
no remission after 2 optimal trials of antidepressants for 6-8 weeks
what is considered “acute phase” of depression?
6-12 weeks
what is considered “continuation” phase of depression?
4-9 months
what is considered “maintenance phase” of depression?
12-36 months
what is the first drug class of choice for a typical case of depression?
SSRI
if pt is not improving “failed” on SSRI, what is the next step?
ensure patient adherence, and if needed switch to different SSRI or non-SSRI antidepressant
if pt only has a partial response to the SSRI, what is the next step?
consider adding a non-SSRI antidepressant or completely switching to a different SSRI or non-SSRI antidepressant
if patient has response or remission, what is the next step?
maintain for at least 4-9 months for continuation, and if necessary 12-36 months for maintenance
what are the only 2 SSRIs FDA approved for kids?
fluoxetine and escitalopram
why is citalopram not a preferred initial treatment?
it has QT prolongation
what drug class of antidepressants should you avoid giving to post-heart attack pts?
TCAs
T/F older patients are more likely to relapse, and less likely to have full remission
true
why is mirtazapine prescribed for depression frequently in older patients?
it has minimal drug interactions, helps with sleep, and increases appetite
what are some typical effects of depression on babies after pregnancy?
low birth weight and prematurity
what are side effects we see in newborns whose mother was taking antidepressants?
persistent pulmonary hypertension
cardiac abnormalities
withdrawal syndome: temporary, no longer-term effects
should women stop taking antidepressants during pregnancy?
they don’t need to stop taking them, it is important to weigh the risks versus benefits
are antidepressants safe while lactating?
considered safe, very small amounts get into breast milk
why does fluoxetine effect breast milk more than other antidepressants?
it has a long half life
what is the most common symptom of depression in children?
inability to focus
what are important counseling points for depression?
-use PHQ-9s at follow-up appointments
-counsel on increased sexual changes, how to combat them? (decreased arousal, libido, sexual function)
-suicidality
-anxiousness, nervousness (use SNRIs)
-if pt is using an SNRI, need to check BP
-let pt know nausea, HAs are common for 1-2 weeks
initial dose of citalopram
10-20mg
initial dose of escitalopram
5-10mg
initial dose of fluoxetine
10-20mg
initial dose of fluvoxamine
25-50mg
initial dose of paroxetine
10-20mg
initial dose of sertraline
25-50
initial dose of desvenlafaxine
50
initial dose of duloxetine
30mg
initial dose of venlafaxine
37.5-75
initial dose of amitriptyline
25mg
initial dose of doxepin
25mg
initial dose of bupropion
75mg bid
initial dose of trazodone
50mg
initial dose of mirtazapine
15mg
initial dose of tranylcypromine
10-20mg
which SSRIs have a t1/2 greater than 24 hours?
citalopram
escitalopram
fluoxetine
paroxetine
all the SNRIs t/12 is around how long? (except venlafaxine)
how long is venlafaxines?
12 hours
5 hours
best TCA to prescribe for longest duration?
nortriptyline
what is mirtazapines t1/2?
20-40 hours
what is bupropion’s t1/2?
10-21 hours
which antidepressants inhibit Cyp2D6?
bupropion
duloxetine
fluoxetine
paroxetine
which antidepressants inhibit Cyp3A4?
fluoxetine
fluvoxamine
nefazodone
what drugs have interactions with antidepressants?
NSAIDs, aspirin, anticoags, antiplatelets, triptans, tramadol
why avoid paroxetine in older adults?
anticholinergic effects: dry mouth, urinary retention
