Therapeutics of Depression

Question 1

what is the PHQ-9?

Answer 1

9 questions of the 9 symptoms of depression

Question 2

how do you interpret a PHQ-9 score?

Answer 2

5 is mild
10 is moderate
20 is severe

Question 3

what does GDS stand for?

Answer 3

geriatric depression scale

Question 4

what does HAM-D stand for?

Answer 4

hamilton rating scale for depression

Question 5

what does MADRS stand for?

Answer 5

montgomery-asberg depression rating scale

Question 6

what does beck depression inventory measure?

Answer 6

behavioral symptoms

Question 7

what is the diagnostic criteria for MDD? (D SIG E CAPS)

Answer 7

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

Question 8

how do you interpret the diagnostic criteria for MDD?

Answer 8

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

Question 9

what are 5 risk factors that lower recovery rates for depression?

Answer 9

-being male
-hopelessness
-adolescent/young adult
-childhood trauma
-physical illness

Question 10

the longer the time between episodes the _____ the risk of recurrence

Answer 10

lower

Question 11

T/F some people’s depression can go away without help

Answer 11

true

Question 12

define dysthymia MDD

Answer 12

someone who does not have 5 symptoms of depression but meets the criteria for MDD for 2 or more years

Question 13

what are other diagnoses that may mimic depression but should be ruled out before diagnosing for depression?

Answer 13

hypothyroidism
low testosterone
chronic diseases
anemia

Question 14

how does chronic opioid use effect testosterone?

Answer 14

lowers testosterone

Question 15

why can anemia show symptoms of depression?

Answer 15

causes low energy

Question 16

should you ask depression patients if they have thoughts of suicide?

Answer 16

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

Question 17

what is an example of passive suicide ideation?

Answer 17

swallowing pills to commit suicide

Question 18

what is an example of active suicide ideation?

Answer 18

using a gun to commit suicide

Question 19

T/F attempts to commit suicide increase with age and older patients are more likely to succeed with suicide

Answer 19

false, attempts to commit suicide decrease with age, but older patients are more likely to complete a suicide attempt

Question 20

T/F men are more likely to attempt suicide but less likely to complete

Answer 20

false, women are

Question 21

define non-response

Answer 21

less than 25% improvement

Question 22

define partial response

Answer 22

26-49% improvement

Question 23

define response

Answer 23

over 50% improvement

Question 24

define remission

Answer 24

no symptoms

Question 25

define treatment resistant depression

Answer 25

no remission after 2 optimal trials of antidepressants for 6-8 weeks

Question 26

what is considered "acute phase" of depression?

Answer 26

6-12 weeks

Question 27

what is considered "continuation" phase of depression?

Answer 27

4-9 months

Question 28

what is considered "maintenance phase" of depression?

Answer 28

12-36 months

Question 29

what is the first drug class of choice for a typical case of depression?

Answer 29

SSRI

Question 30

if pt is not improving "failed" on SSRI, what is the next step?

Answer 30

ensure patient adherence, and if needed switch to different SSRI or non-SSRI antidepressant

Question 31

if pt only has a partial response to the SSRI, what is the next step?

Answer 31

consider adding a non-SSRI antidepressant or completely switching to a different SSRI or non-SSRI antidepressant

Question 32

if patient has response or remission, what is the next step?

Answer 32

maintain for at least 4-9 months for continuation, and if necessary 12-36 months for maintenance

Question 33

what are the only 2 SSRIs FDA approved for kids?

Answer 33

fluoxetine and escitalopram

Question 34

why is citalopram not a preferred initial treatment?

Answer 34

it has QT prolongation

Question 35

what drug class of antidepressants should you avoid giving to post-heart attack pts?

Answer 35

TCAs

Question 36

T/F older patients are more likely to relapse, and less likely to have full remission

Answer 36

true

Question 37

why is mirtazapine prescribed for depression frequently in older patients?

Answer 37

it has minimal drug interactions, helps with sleep, and increases appetite

Question 38

what are some typical effects of depression on babies after pregnancy?

Answer 38

low birth weight and prematurity

Question 39

what are side effects we see in newborns whose mother was taking antidepressants?

Answer 39

persistent pulmonary hypertension cardiac abnormalities withdrawal syndome: temporary, no longer-term effects

Question 40

should women stop taking antidepressants during pregnancy?

Answer 40

they don't need to stop taking them, it is important to weigh the risks versus benefits

Question 41

are antidepressants safe while lactating?

Answer 41

considered safe, very small amounts get into breast milk

Question 42

why does fluoxetine effect breast milk more than other antidepressants?

Answer 42

it has a long half life

Question 43

what is the most common symptom of depression in children?

Answer 43

inability to focus

Question 44

what are important counseling points for depression?

Answer 44

-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

Question 45

initial dose of citalopram

Answer 45

10-20mg

Question 46

initial dose of escitalopram

Answer 46

5-10mg

Question 47

initial dose of fluoxetine

Answer 47

10-20mg

Question 48

initial dose of fluvoxamine

Answer 48

25-50mg

Question 49

initial dose of paroxetine

Answer 49

10-20mg

Question 50

initial dose of sertraline

Answer 50

25-50

Question 51

initial dose of desvenlafaxine

Answer 51

50

Question 52

initial dose of duloxetine

Answer 52

30mg

Question 53

initial dose of venlafaxine

Answer 53

37.5-75

Question 54

initial dose of amitriptyline

Answer 54

25mg

Question 55

initial dose of doxepin

Answer 55

25mg

Question 56

initial dose of bupropion

Answer 56

75mg bid

Question 57

initial dose of trazodone

Answer 57

50mg

Question 58

initial dose of mirtazapine

Answer 58

15mg

Question 59

initial dose of tranylcypromine

Answer 59

10-20mg

Question 60

which SSRIs have a t1/2 greater than 24 hours?

Answer 60

citalopram escitalopram fluoxetine paroxetine

Question 61

all the SNRIs t/12 is around how long? (except venlafaxine) how long is venlafaxines?

Answer 61

12 hours 5 hours

Question 62

best TCA to prescribe for longest duration?

Answer 62

nortriptyline

Question 63

what is mirtazapines t1/2?

Answer 63

20-40 hours

Question 64

what is bupropion's t1/2?

Answer 64

10-21 hours

Question 65

which antidepressants inhibit Cyp2D6?

Answer 65

bupropion duloxetine fluoxetine paroxetine

Question 66

which antidepressants inhibit Cyp3A4?

Answer 66

fluoxetine fluvoxamine nefazodone

Question 67

what drugs have interactions with antidepressants?

Answer 67

NSAIDs, aspirin, anticoags, antiplatelets, triptans, tramadol

Question 68

why avoid paroxetine in older adults?

Answer 68

anticholinergic effects: dry mouth, urinary retention