Trintellix Module 4 Flashcards
Name the major classes of antidepressant drugs used in MDD treatment.
TCA TeCA MaOI serotonin modulators NDRI SSRI SNRI NOepinephrine-serotonin modulator SSRI and 5-HT1a partial receptor agonist atypical antipsychotics
What does TCA stand for?
Tricyclis antidepressants
What does TeCA stand for?
tertracyclic antidepressants
What does MAOI stand for?
Monoamine oxidase inhibitors
Whats does NDRI stand for?
norepinephrine and dopamine reuptake inhibitor
What does SNRI stand for?
serotonin norepinephrine reuptake inhibitor.
What are the patient related considerations that can effect the selection of antidepressant therapy?
preference
previous antidepressant response
adherence to treatment
comorbid psychiatric and general medical conditions
family history of response to certain medications.
What are the drug related considerations that can effect the selection of antidepressant therapy?
safety tolerability side effects potential drug interactions half life cost
Name the non- pharmacologic treatments.
Psychotherapy
CBT
brain stimulating therapies
complementary and alternative therapies
What is CBT?
cognitive behavioral therapy
What therapies are associated with psychotherapy and counseling?
IPT
psychodynamic psychotherapy
marital and family therapy
What is IPT?
interpersonal psychotherapy
What therapies are associated with CBT?
coping skills
problem solving
cognition restructuring
What therapies are associated with brain stimulating therapies?
ECT
TMS
VNS
What is ECT?
Electroconvulsive therapy
What is TMS?
transcranial magnetic stimulation.
What is VNS?
Vagus nerve stimulation.
What therapies are associated with complementary and alternative treatments?
st. johns wart
S-sdenosyl methionine (SAMe)
Omega fatty acids
folate
Define what is meant by response as related to MDD
Reduction by 50% in the measured severity of depression.
Define what is meant by remission as related to MDD?
absence of both sad mood and reduced interest for at least 3 week, and no more than 3 remaining symptoms of the major depressive episode.
Define what is meant by recovery as related to MDD?
remission of symptoms and return to full functioning and quality of life.
Define what is meant by relapse as related to MDD?
re-emergence of significant depressive symptoms of dysfunction during the acute or continuation phases of the treatment.
What is the goal of the acute phase of MDD treatment?
to induce remission of symptoms and achieve a full return to the patients level of functioning.
List the therapies for the acute phase of MDD treatment as recommended by the APA.
Pharmacotherapy
psychotherapy
Brain stimulating therapy
What is the goal of the continuation phase of MDD treatment?
to prevent relapse
summarize the approach of the continuation phase of MDD treatment.
remain on therapy that was effective in the acute phase at the same dosage and frequency.
consider CBT or other psychotherapy, if not already in use.
patients receiving ECT during acute phase may be switched to pharmacotherapy.
monitor regularly using assessment tools.
What is the goal of the maintenance phase of MDD treatment?
to protect susceptible patients against recurrence of subsequent depression.
Summarized the approach for the maintenance phase of MDD treatment.
remain on pharmacotherapy that produced symptom remission in acute and continuation phase at full therapeutic dose.
continue psychotherapy used in acute and continuation phase at reduced dose.
maintain ECT or VNS if already in use and effictive ( ECT at reduced dose)
monitor regularly using assessment tools
Describe the Kupfer curve.
the progression of patients through 3 phase of treatment for MDD and how they evolve over time.
In the Kupfer curve following the __________ phase of treatment and at the beginning of the_______ phase patients may be considered in recovery.
continuation, maintenance
once in the ____________ phase a patient may experience a recurrence, or the presentation of a_________ after being asymptomatic.
maintenance, depressive episode
Because______takes place following_________ on the Kupfer curve, is considered to be a new and distinct episode of depression.
recurrence, recovery
According to the INSTEL what where the 3 most common symptoms seen throughout the course of depression?
cognitive problems, lack of energy, sleep problems.
According to INSTEL study what was the proportion of time cognitive problems was reported during and between studies.
94%,44%
According to INSTEL study what was the proportion of time lack of energy was reported during and between studies.
90%,35%
According to INSTEL study what was the proportion of time sleep problems was reported during and between studies.
85%,39%
According to INSTEL study what was the proportion of time depressed mood was reported during and between studies.
100%,21%
Describe the key clinical needs in MDD as they relate to frequent failure of inital therapy.
50% of do not respond to initial treatment.
during acute phase 65% to 80% fail to achieve remission
20% to 30% respond but have residual symptoms.
Antidepressant therapies are associated with a variety of ________ and _________ side effects that range from bothersome to potentially life threatening.
short term and long term
Patients who do not respond to therapy or who onyl respond partially have significantly ______________, significantly worse___________ and worse__________compared to those who experienced remission.
poorer quality of life
psycho social functioning
overall well being
non responders and partial responders have significantly more______, more-_____ and significantly higher_______ .
annual office visits
hospital days
healthcare costs
What are the short term treatment emergent side effects of antidepressant treatment?
headaches, nausea, vomiting and diarrhea. tend to be transient and treatable.
What are the long term treatment emergent side effects of antidepressant treatment?
sexual side effects and weight gain. not transient and may effect adherence to treatment.
List the most common residual depressive symptoms that patients experience despite being in remission.
sleep disturbance appetite/weight disturbance sad mood decreases energy decreased concentration
What are the challenges to adherence during the acute phase?
poor motivation
pessimism about recovery
memory deficits
poor self care
What are the challenges during the continuation and maintenance phases?
undervalue benefits of continued treatment
focus on burdens of treatment
What are the challenges during pharmacotherapy treatment?
side effects
lack of involvement in medicine choice.
What are the challenges during psychotherapy?treatment.
anxiety as patients confront fearful or difficult topics.
