Therapeutics of MDD

Question 1

TCA TDM

Answer 1

After 5 days (steady state)

Get trough 12 hours after first dose

Question 2

Which SSRIs do we want to avoid in elderly and WHY?

Answer 2

Fluoxetine and fluvoxamine

Longest half lives

Question 3

Who is the dirty SSRI and WHY?

Answer 3

Paroxetine
Highest anticholinergic and antihistaminergic side effects
Greatest weight gain
Shortest acting

Question 4

What are the SSRI drug interactions and who has the least/most?

Answer 4

CYPs
Citalopram and escitalopram have the least
Fluvoxamine has the most

Question 5

Which SSRI has the greatest risk of QTc prolongation?

Answer 5

Citalopram

Question 6

Which SNRI has the least drug interactions?

Answer 6

Duloxetine

Question 7

SARIs

Answer 7

Trazodone

Question 8

First Line Treatment Options (Pharma)

Answer 8

SSRIs, SNRIs, Remeron, Bupropion

Question 9

Treatment Resistant: Next Steps

Answer 9

Switch (same or different class)
Add another antidepressant
Add augmentation med

Question 10

Augmentation Meds

Answer 10

Lithium
Stimulants
Pindolol
Anticonvulsants
Thyroid hormone
SGAs (Abilify and Seroquel XR)

Question 11

What is crucial about MAOi and serotonin syndrome?

Answer 11

Happens for sure if you don’t allow for a washout period

D/c med for 2 weeks before switching

Question 12

Discontinuation Syndrome

Answer 12

Flu-like prodrome 1-2 days after stopping and lasting about 1-2 weeks!

Question 13

DSIGECAPS

Answer 13

Depressed mood
Sleep
Interests
Guilty
Energy
Concentration
Appetite
Psychomotor
Suicidal