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IDT Fall > Therapeutics of Depression > Flashcards

Therapeutics of Depression Flashcards

1
Q

what is the PHQ-9?

A

9 questions of the 9 symptoms of depression

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2
Q

how do you interpret a PHQ-9 score?

A

5 is mild
10 is moderate
20 is severe

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3
Q

what does GDS stand for?

A

geriatric depression scale

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4
Q

what does HAM-D stand for?

A

hamilton rating scale for depression

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5
Q

what does MADRS stand for?

A

montgomery-asberg depression rating scale

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6
Q

what does beck depression inventory measure?

A

behavioral symptoms

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7
Q

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

A

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

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8
Q

how do you interpret the diagnostic criteria for MDD?

A

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

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9
Q

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

A

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

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10
Q

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

A

lower

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11
Q

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

A

true

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12
Q

define dysthymia MDD

A

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

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13
Q

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

A

hypothyroidism
low testosterone
chronic diseases
anemia

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14
Q

how does chronic opioid use effect testosterone?

A

lowers testosterone

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15
Q

why can anemia show symptoms of depression?

A

causes low energy

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16
Q

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

A

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

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17
Q

what is an example of passive suicide ideation?

A

swallowing pills to commit suicide

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18
Q

what is an example of active suicide ideation?

A

using a gun to commit suicide

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19
Q

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

A

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

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20
Q

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

A

false, women are

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21
Q

define non-response

A

less than 25% improvement

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22
Q

define partial response

A

26-49% improvement

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23
Q

define response

A

over 50% improvement

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24
Q

define remission

A

no symptoms

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25
Q

define treatment resistant depression

A

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

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26
Q

what is considered “acute phase” of depression?

A

6-12 weeks

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27
Q

what is considered “continuation” phase of depression?

A

4-9 months

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28
Q

what is considered “maintenance phase” of depression?

A

12-36 months

29
Q

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

A

SSRI

30
Q

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

A

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

31
Q

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

A

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

32
Q

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

A

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

33
Q

what are the only 2 SSRIs FDA approved for kids?

A

fluoxetine and escitalopram

34
Q

why is citalopram not a preferred initial treatment?

A

it has QT prolongation

35
Q

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

A

TCAs

36
Q

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

A

true

37
Q

why is mirtazapine prescribed for depression frequently in older patients?

A

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

38
Q

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

A

low birth weight and prematurity

39
Q

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

A

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

40
Q

should women stop taking antidepressants during pregnancy?

A

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

41
Q

are antidepressants safe while lactating?

A

considered safe, very small amounts get into breast milk

42
Q

why does fluoxetine effect breast milk more than other antidepressants?

A

it has a long half life

43
Q

what is the most common symptom of depression in children?

A

inability to focus

44
Q

what are important counseling points for depression?

A

-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

45
Q

initial dose of citalopram

A

10-20mg

46
Q

initial dose of escitalopram

A

5-10mg

47
Q

initial dose of fluoxetine

A

10-20mg

48
Q

initial dose of fluvoxamine

A

25-50mg

49
Q

initial dose of paroxetine

A

10-20mg

50
Q

initial dose of sertraline

A

25-50

51
Q

initial dose of desvenlafaxine

A

50

52
Q

initial dose of duloxetine

A

30mg

53
Q

initial dose of venlafaxine

A

37.5-75

54
Q

initial dose of amitriptyline

A

25mg

55
Q

initial dose of doxepin

A

25mg

56
Q

initial dose of bupropion

A

75mg bid

57
Q

initial dose of trazodone

A

50mg

58
Q

initial dose of mirtazapine

A

15mg

59
Q

initial dose of tranylcypromine

A

10-20mg

60
Q

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

A

citalopram
escitalopram
fluoxetine
paroxetine

61
Q

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

A

12 hours
5 hours

62
Q

best TCA to prescribe for longest duration?

A

nortriptyline

63
Q

what is mirtazapines t1/2?

A

20-40 hours

64
Q

what is bupropion’s t1/2?

A

10-21 hours

65
Q

which antidepressants inhibit Cyp2D6?

A

bupropion
duloxetine
fluoxetine
paroxetine

66
Q

which antidepressants inhibit Cyp3A4?

A

fluoxetine
fluvoxamine
nefazodone

67
Q

what drugs have interactions with antidepressants?

A

NSAIDs, aspirin, anticoags, antiplatelets, triptans, tramadol

68
Q

why avoid paroxetine in older adults?

A

anticholinergic effects: dry mouth, urinary retention

IDT Fall (29 decks)

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