Therapy of Depression

Question 1

When starting antidepressants, what should you inform the patient of?

Answer 1

That adverse effects might occur
immediately, while resolution of symptoms may take 2 - 4 weeks or longer.

Question 2

Which of these is best tolerated? SSRIs, TCAs, or MAOIs?

Answer 2

SSRIs

Question 3

Which acne treatment is associated with or exacerbates depressive symptoms?

Answer 3

Isotretinoin

Question 4

Which Anticonvulsants are associated with or exacerbate depressive symptoms?

Answer 4

1) Levetiracetam
2) Topiramate
3) Vigabatrin

Question 5

Which Antimigraine agents are associated with or exacerbate depressive symptoms?

Answer 5

Triptans

Question 6

Which Cardiovascular medications are associated with or exacerbate depressive symptoms?

Answer 6

1) β-Blockers
2) Clonidine
3) Reserpine
4) Methyldopa

Question 7

Which hormonal therapies are associated with or exacerbate depressive symptoms?

Answer 7

1) Gonadotropin-releasing hormone
2) Oral contraceptives
3) Steroids (Prednisone)
4) Tamoxifen

Question 8

Which Immunologic agents are associated with or exacerbate depressive symptoms?

Answer 8

Interferons

Question 9

Which smoking cessation medications are associated with or exacerbate depressive symptoms?

Answer 9

Varenicline

Question 10

Which medical conditions are associated with depression?

Answer 10

1) Stroke
2) Parkinson’s disease
3) Traumatic brain injury
4) Hypothyroidism
5) Withdrawal from cocaine and other stimulants

Question 11

The goals of depression treatment are:

Answer 11

1) The resolution of current symptoms (remission)
2) The prevention of further episodes (relapse or recurrence)

Question 12

The decision to hospitalize a depressive patient depends on:

Answer 12

1) Patient’s risk of suicide
2) Physical state of health
3) Social support
4) Presence of a psychotic depression

Question 13

What are the phases of depression therapy?

Answer 13

1) Acute phase
2) Continuation phase
3) Maintenance phase

Question 14

How long does the acute phase of depression therapy last?

Answer 14

6-12 weeks

Question 15

How long does the continuation phase of depression therapy last?

Answer 15

4-9 months

Question 16

How long does the maintenance phase of depression therapy last?

Answer 16

12-36 months

Question 17

What is the goal of the acute phase of depression therapy?

Answer 17

Remission (disappearance of symptoms)

Question 18

What is the goal of the continuation phase of depression therapy?

Answer 18

Eliminate residual symptoms or prevent relapse (return of symptoms within 6 months of remission)

Question 19

What is the goal of the maintenance phase of depression therapy?

Answer 19

Prevent recurrence (a separate episode of depression which returns months-years after recovery)

Question 20

The duration of antidepressant therapy depends on the:

Answer 20

Risk of recurrence

Question 21

Risk of depression recurrence increases as:

Answer 21

The number of past episodes increases

Question 22

Some recommend life-long maintenance therapy for which patients?

Answer 22

1) Patients >40 years of age
WITH ≥2 prior episodes
AND
2) Patients of any age with ≥3 prior episodes.

Question 23

An alternative approach is to treat for at least ___ in patients considered to be at high risk for relapse.

Answer 23

2 years

Question 24

The decision when to taper/discontinue an antidepressant regimen depends on:

Answer 24

1) Patient-specific variables
2) Drug-specific variables

Question 25

The precise rate of the antidepressant taper typically depends on:

Answer 25

1) Medication half-life 2) Patient sensitivity to withdrawal symptoms

Question 26

Monitoring for what is very necessary when treating for depression?

Answer 26

1) Discontinuation signs and symptoms 2) For a return of depressive symptoms

Question 27

Can you treat depression with psychotherapy alone?

Answer 27

NO

Question 28

___ is a safe and effective treatment for certain severe mental illnesses, including MDD.

Answer 28

Electroconvulsive therapy (ECT)

Question 29

Which psychotherapies can be used for depression?

Answer 29

1) Cognitive therapy 2) Behavioral therapy 3) Interpersonal psychotherapy 4) Electroconvulsive therapy (ECT)

Question 30

What are the classes of therapeutic drugs?

Answer 30

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)

Question 31

Which drugs are Selective Serotonin Reuptake Inhibitors (SSRIs)?

Answer 31

1) Citalopram 2) Escitalopram 3) Fluoxetine 4) Fluvoxamine 5) Paroxetine 6) Sertraline

Question 32

Which SSRIs demonstrate the ‘best’ effect and safety profile?

Answer 32

1) Escitalopram 2) Sertraline

Question 33

Which drug is an NDRI?

Answer 33

Bupropion

Question 34

What is Bupropion usually used for?

Answer 34

Smoking cessation programs

Question 35

Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs) are divided into:

Answer 35

1) Tricyclic antidepressants (TCAs) 2) Newer-generation SNRIs

Question 36

Tricyclic antidepressants (TCAs) consist of which drugs?

Answer 36

1) Amitriptyline 2) Desipramine 3) Doxepin 4) Imipramine 5) Nortriptyline

Question 37

TCAs affect other receptor systems, such as:

Answer 37

1) Cholinergic receptors 2) Histaminergic receptors 3) α-adrenergic receptors

Question 38

TCAs have ___(many/few) adverse effects.

Answer 38

Many

Question 39

Newer-generation SNRIs consist of which drugs?

Answer 39

1) Desvenlafaxine 2) Duloxetine 3) Venlafaxine 4) Levomilnacipran

Question 40

Which newer-generation SNRI may be associated with higher rates of response and remission?

Answer 40

Venlafaxine

Question 41

Which drugs have Mixed Serotonergic Effects?

Answer 41

1) Nefazodone 2) Trazodone 3) Vilazodone 4) Vortioxetine

Question 42

Trazodone act as both:

Answer 42

1) 5-HT2 antagonists 2) 5-HT reuptake inhibitors

Question 43

Trazodone enhances:

Answer 43

5-HT1A-mediated neurotransmission

Question 44

What mechanism of action does Trazodone have that leads to increased adverse effects (dizziness and sedation) that limit its use?

Answer 44

It blocks α1-adrenergic and histaminergic receptors

Question 45

Trazodone may be used adjunctively (in low doses) to induce ___ among depressed patients who are taking other antidepressant medications.

Answer 45

Sleep (Tra**zzz**odone)

Question 46

Which drug is a Serotonin and α2-Adrenergic Antagonist?

Answer 46

Mirtazapine

Question 47

Which drugs are Monoamine Oxidase Inhibitors (MAOIs)?

Answer 47

1) Phenelzine 2) Selegiline 3) Tranylcypromine

Question 48

MAOIs inhibit the MAO enzyme, therefore increasing the concentrations of:

Answer 48

1) NE 2) 5-HT 3) DA

Question 49

Chronic therapy of MAOIs causes downregulation of:

Answer 49

1) β-adrenergic receptors 2) α-adrenergic receptors 3) Serotonergic receptors

Question 50

Which MAOIs are nonselective inhibitors of MAO-A and MAO-B?

Answer 50

1) Phenelzine 2) Tranylcypromine

Question 51

Which MAOI inhibits both MAO-A and MAO-B in the brain, yet has reduced effects on MAO-A in the gut?

Answer 51

Selegiline

Question 52

Selegiline inhibits both MAO-A and MAO-B in the __.

Answer 52

Brain

Question 53

Selegiline has reduced effects on ___ in the gut.

Answer 53

MAO-A

Question 54

Antidepressants are considered first-line treatment for:

Answer 54

Moderate -severe depressive episodes

Question 55

Why is the choice of antidepressant empiric?

Answer 55

Because one cannot predict which antidepressant will be the most effective in an individual patient.

Question 56

Factors that often influence the choice of an antidepressant include:

Answer 56

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

Question 57

Preferred antidepressants for symptoms of Anxiety?

Answer 57

Selective Serotonin Reuptake Inhibitors

Question 58

Preferred antidepressants for symptoms of Weight loss and Reduced appetite?

Answer 58

Serotonin and α2-Adrenergic Antagonists (Mirtazapine)

Question 59

Preferred antidepressants for symptoms of Sleep disturbance and Insomnia?

Answer 59

1) Mirtazapine 2) TCAs 3) Mixed Serotonergic drugs (Trazodone)

Question 60

Preferred antidepressants for symptoms of Cognitive difficulties?

Answer 60

Selective Serotonin Reuptake Inhibitors

Question 61

The most common adverse effects of SSRIs are:

Answer 61

1) Nausea 2) Vomiting 3) Diarrhea 4) Sexual dysfunction 5) Headache 6) Insomnia 7) Withdrawal syndrome

Question 62

Citalopram and Escitalopram produce dose-dependent:

Answer 62

Prolongation of QT interval

Question 63

The most common adverse effects of TCAs (SNRIs) are:

Answer 63

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

Question 64

TCA overdose can cause:

Answer 64

Severe cardiac arrhythmias and increased risk of death

Question 65

The most common adverse effects of Venlafaxine are:

Answer 65

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