Therapy of Depression Flashcards
When starting antidepressants, what should you inform the patient of?
That adverse effects might occur
immediately, while resolution of symptoms may take 2 - 4 weeks or longer.
Which of these is best tolerated? SSRIs, TCAs, or MAOIs?
SSRIs
Which acne treatment is associated with or exacerbates depressive symptoms?
Isotretinoin
Which Anticonvulsants are associated with or exacerbate depressive symptoms?
1) Levetiracetam
2) Topiramate
3) Vigabatrin
Which Antimigraine agents are associated with or exacerbate depressive symptoms?
Triptans
Which Cardiovascular medications are associated with or exacerbate depressive symptoms?
1) β-Blockers
2) Clonidine
3) Reserpine
4) Methyldopa
Which hormonal therapies are associated with or exacerbate depressive symptoms?
1) Gonadotropin-releasing hormone
2) Oral contraceptives
3) Steroids (Prednisone)
4) Tamoxifen
Which Immunologic agents are associated with or exacerbate depressive symptoms?
Interferons
Which smoking cessation medications are associated with or exacerbate depressive symptoms?
Varenicline
Which medical conditions are associated with depression?
1) Stroke
2) Parkinson’s disease
3) Traumatic brain injury
4) Hypothyroidism
5) Withdrawal from cocaine and other stimulants
The goals of depression treatment are:
1) The resolution of current symptoms (remission)
2) The prevention of further episodes (relapse or recurrence)
The decision to hospitalize a depressive patient depends on:
1) Patient’s risk of suicide
2) Physical state of health
3) Social support
4) Presence of a psychotic depression
What are the phases of depression therapy?
1) Acute phase
2) Continuation phase
3) Maintenance phase
How long does the acute phase of depression therapy last?
6-12 weeks
How long does the continuation phase of depression therapy last?
4-9 months
How long does the maintenance phase of depression therapy last?
12-36 months
What is the goal of the acute phase of depression therapy?
Remission (disappearance of symptoms)
What is the goal of the continuation phase of depression therapy?
Eliminate residual symptoms or prevent relapse (return of symptoms within 6 months of remission)
What is the goal of the maintenance phase of depression therapy?
Prevent recurrence (a separate episode of depression which returns months-years after recovery)
The duration of antidepressant therapy depends on the:
Risk of recurrence
Risk of depression recurrence increases as:
The number of past episodes increases
Some recommend life-long maintenance therapy for which patients?
1) Patients >40 years of age
WITH ≥2 prior episodes
AND
2) Patients of any age with ≥3 prior episodes.
An alternative approach is to treat for at least ___ in patients considered to be at high risk for relapse.
2 years
The decision when to taper/discontinue an antidepressant regimen depends on:
1) Patient-specific variables
2) Drug-specific variables
The precise rate of the antidepressant taper typically depends on:
1) Medication half-life
2) Patient sensitivity to withdrawal symptoms
Monitoring for what is very necessary when treating for depression?
1) Discontinuation signs and symptoms
2) For a return of depressive symptoms
Can you treat depression with psychotherapy alone?
NO
___ is a safe and effective treatment for certain severe mental illnesses, including MDD.
Electroconvulsive therapy (ECT)
Which psychotherapies can be used for depression?
1) Cognitive therapy
2) Behavioral therapy
3) Interpersonal psychotherapy
4) Electroconvulsive therapy (ECT)
What are the classes of therapeutic drugs?
1) Selective Serotonin Reuptake Inhibitors (SSRIs)
2) Norepinephrine - Dopamine Reuptake Inhibitors (NDRI)
3) Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)
4) Mixed Serotonergic Effects
5) Serotonin and α2-Adrenergic Antagonists
6) Monoamine Oxidase Inhibitors (MAOIs)
Which drugs are Selective Serotonin Reuptake Inhibitors (SSRIs)?
1) Citalopram
2) Escitalopram
3) Fluoxetine
4) Fluvoxamine
5) Paroxetine
6) Sertraline
Which SSRIs demonstrate the ‘best’ effect and safety profile?
1) Escitalopram
2) Sertraline
Which drug is an NDRI?
Bupropion
What is Bupropion usually used for?
Smoking cessation programs
Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs) are divided into:
1) Tricyclic antidepressants (TCAs)
2) Newer-generation SNRIs
Tricyclic antidepressants (TCAs) consist of which drugs?
1) Amitriptyline
2) Desipramine
3) Doxepin
4) Imipramine
5) Nortriptyline
TCAs affect other receptor systems, such as:
1) Cholinergic receptors
2) Histaminergic receptors
3) α-adrenergic receptors
TCAs have ___(many/few) adverse effects.
Many
Newer-generation SNRIs consist of which drugs?
1) Desvenlafaxine
2) Duloxetine
3) Venlafaxine
4) Levomilnacipran
Which newer-generation SNRI may be associated with higher rates of response and remission?
Venlafaxine
Which drugs have Mixed Serotonergic Effects?
1) Nefazodone
2) Trazodone
3) Vilazodone
4) Vortioxetine
Trazodone act as both:
1) 5-HT2 antagonists
2) 5-HT reuptake inhibitors
Trazodone enhances:
5-HT1A-mediated neurotransmission
What mechanism of action does Trazodone have that leads to increased adverse effects (dizziness and sedation) that limit its use?
It blocks α1-adrenergic and histaminergic receptors
Trazodone may be used adjunctively (in low doses) to induce ___ among depressed patients who are taking other antidepressant medications.
Sleep (Trazzzodone)
Which drug is a Serotonin and α2-Adrenergic Antagonist?
Mirtazapine
Which drugs are Monoamine Oxidase Inhibitors (MAOIs)?
1) Phenelzine
2) Selegiline
3) Tranylcypromine
MAOIs inhibit the MAO enzyme, therefore increasing the concentrations of:
1) NE
2) 5-HT
3) DA
Chronic therapy of MAOIs causes downregulation of:
1) β-adrenergic receptors
2) α-adrenergic receptors
3) Serotonergic receptors
Which MAOIs are nonselective inhibitors of MAO-A and MAO-B?
1) Phenelzine
2) Tranylcypromine
Which MAOI inhibits both MAO-A and MAO-B in the brain, yet has reduced effects on MAO-A in the gut?
Selegiline
Selegiline inhibits both MAO-A and MAO-B in the __.
Brain
Selegiline has reduced effects on ___ in the gut.
MAO-A
Antidepressants are considered first-line treatment for:
Moderate -severe depressive episodes
Why is the choice of antidepressant empiric?
Because one cannot predict which antidepressant will be the most effective in an individual patient.
Factors that often influence the choice of an antidepressant include:
1) The patient’s history of response
2) Presenting symptoms
3) Potential for drug–drug interactions
4) Adverse effect profile
5) Patient preference
6) Drug cost
Preferred antidepressants for symptoms of Anxiety?
Selective Serotonin Reuptake Inhibitors
Preferred antidepressants for symptoms of Weight loss and Reduced appetite?
Serotonin and α2-Adrenergic Antagonists (Mirtazapine)
Preferred antidepressants for symptoms of Sleep disturbance and Insomnia?
1) Mirtazapine
2) TCAs
3) Mixed Serotonergic drugs (Trazodone)
Preferred antidepressants for symptoms of Cognitive difficulties?
Selective Serotonin Reuptake Inhibitors
The most common adverse effects of SSRIs are:
1) Nausea
2) Vomiting
3) Diarrhea
4) Sexual dysfunction
5) Headache
6) Insomnia
7) Withdrawal syndrome
Citalopram and Escitalopram produce dose-dependent:
Prolongation of QT interval
The most common adverse effects of TCAs (SNRIs) are:
1) Dose-related Anticholinergic effects:
a) Dry mouth
b) Constipation
c) Blurred vision
d) Urinary retention
e) Dizziness
f) Tachycardia
g) Memory impairment
h) Delirium
2) Weight gain
3) Sexual dysfunction
4) Orthostatic hypotension
5) Cardiac conduction delays and heart block
TCA overdose can cause:
Severe cardiac arrhythmias and increased risk of death
The most common adverse effects of Venlafaxine are:
1) Sexual dysfunction
2) Nausea and Vomiting
3) Dose-related increase in blood pressure
4) Dry mouth
5) Constipation
6) Decreased appetite
7) Insomnia
8) Increased sweating
