Therapeutics of Depression Flashcards
What are the two (at least ONE) symptoms of depression that must be present
Depressed mood and anhedonia
When would pyschotherapy be used for a patient with depression
Less severe disorder with NO PSYCHOTIC presentation (NOT for SEVERE)
T/F: Electroconvulsive therapy is effective for severe depression refactory to drugs, depression with psychosis, or severe suicidal ideation
True
T/F: Electroconvulsive therapy can be used in pregnant and old frail patients
True
What are the TCAs used in depression
Impiramine, despiramine, nortriptyline, amitryptiline
What are the MAOIs used in depression
Isocarboxazid, phenelzine, tranylcypromine
What are the SSRIs used in depression
Fluoxetine,Sertraline, Paroxetine, citalopram, escitalopram
What are the atypical antidepressants
Bupropion, mirtazapine, nefazodone, vilazadone, vortioextine
What is norepinephrine associated with
FOCUSED ATTENTION,elevated energy, motivation to win a reward
What is serotonin (5-HT) associated with
Anxiety, obsessional therapy, mood, sleep, apetite
What is the reward neurotransmitter, what is associated with it
Dopamine/ joy for life, pleasure and euphoria
What serotonin receptor is known for causing nausea and vomitting, why, how can this be reversed
5-HT3, 95% of serotonin is in the gut, antagonists have anti-emetic properties
What are properties are associated with 5-HT2 receptors
anixety and sexual dysfunction (antagonist will improve)
What happens when histamine-1 receptors are ANTAGONIZED
Increased appetite (weight gain), sedation
What are side effects of muscarinic antagonism
constipation, dry mouth, drowsiness, confusion, poor memory
What happens with alpha-1 antagonism
orthostatic hypotension
T/F: TCA block the reuptake of serotonin and norepinephrine
True
What are the side effects of TCAs
orthostatic hypotension (alpha-1 antagonist), weight gain, sedation( histamine-1 antagonism), urinary retention, constipation, dry mouth, memory impairment (anti muscarinic)
What serious side effect of TCA cause Torsade De pointes, how, resolved
Cardiarrhythmias (with seizures), Na channel blockade, sodium bicarbonate
What patients have ABSOLUTE Contraindications to TCA
Cardiovascular disease and history of seizures
T/F: If pain is to be blocked then serotonin blockage is required
False: If pain is to be blocked then NOREPINEPHRINE should be blocked
Which TCAs are active metabolites causing lower incidence of side effects
Despiramine and nortriptyline
What is the side effects of MAOIs
sleep disturbance, ORTHOSTATIC HYPOTENSION, sexual dysfunction, weight gain
What are drug-drug interaction consequences when MAO-I are used with other medications, what antibotic can cause this syndrome when administered with MAOI
Serotonin syndrome, linezolid
Which SSRI adverse effects are transient, not transient
jitteriness, insomnia, GI disturbances/ sexual dysfunction
Which SSRI is the safest in pregnancy
Sertraline
What can be used as an antidote in serotonin syndrome
Cyproheptadine
Since sexual dysfunction is associated with SSRIs what other antidepressants can be given
Bupropion (possible add-on), nefazodone, mirtazipine
What are the consequences of abruptly stopping an SSRI, what are the symptoms (Hint: FINISH)
Discontinuation Syndrome F: Flu-like syndrome I: Insomnia N: Nausea I: Imbalance S: Sensation of shock in the arms, legs or head H: Hyperarousal
What are the two antidepressants that MUST be tapered, which SSRI doesn’t need to and why
Paroxetine and Venlafaxine, Fluoxetine due to the long half life of the drug and its metabolite (best if adherence is bad)
What is the hierachy among SSRIs with regards to insomnia
Fluoxetine (minimize insomnia) -> sertraline -> citalopram -> paroxetine (causes insomnia)
Which SSRI have the least amount of drug-drug interactions
Sertraline and Citalopram
T/F: SSRIs can work in depression and anxiety
True
What class of antidepressants have serotonin reuptake at low doses and more prenounced norepinephrine reuptake inhibition at high doses
Seortonin Norepinephrine Receptor inhibitors (SNRIs)
What are adverse effects of Venlafaxine
Increase in blood pressure that isn’t clinically significant (unless uncontrolled hypertension), abrupt discontinuation can lead to withdrawal similar to SSRIs. Nausea
What is the active metabolite of venlafaxine, what is the advantage of giving it over venlafaxine
Desvenlafaxine, No significant Drug interactions
Which SNRI is also used for pain in other diseases (osteoarthritis, diabetic neuropathy)
Duloxetine
What are the key points about Trazodone
Little to no sexual dysfunction (antagonist of 5HT-2), orthostatic hypotension, VERY SEDATING, priapism (rare)
What atypical antidepressant is associated with heptatoxicity, other facts
Nefazadone/ effective in anxiety and insomnia, LESS sexual dysfucntion
What class of medication is an inhibitor of presynaptic dopmamine and NE reuptake, common side effects, contraindication
Bupropion, MOST activation, insomnia, loss of appetite (weight loss), SEIZURES and anorexia
T/F:Bupropion improves sexual dysfunction and is effective for treatment of anxiety
False: Bupropion does improve sexual dysfunction BUT is NOT EFFECTIVE for treatment of anxiety due to no interaction with serotonin
What receptors does mirtazipine antagonize, what are the effects
5-HT2 receptor antagonism: less AD-induced sexual dysfunction and anxiety
5-HT3 receptor antagonism: improves GI problems such as nausea
H1 antagonism: Increased appetite and SEDATION (side effects)
T/F: SSRIs and SNRIs have are equally efficacious and are effective for anxiety disorders
True
What medications can be used for chronic pain
Duloxetine and TCAs
What are the energizing antidepressants
Bupropion, fluoxetine, venlafaxine
How long should antidepressants be taken to see a response, full effect
At least 2 weeks, 6 to 12 weeks
What are the most sedating antidepressants
Paroxetine and mirtazapine
If a patient has CAD what antidepressants should be avoided, SNRIs
TCA, SNRIs
