Unit 3-4: Prescribing for Depressive Disorders Flashcards
Which drug classes are preferred for individuals with Major Depressive Disorder (MDD) with no comorbidities?
Any SSRI or SNRI.
Which SSRIs are marginally preferred due to their low side-effect profile?
Sertraline (Zoloft) and Escitalopram (Cipralex).
What symptoms are best treated with SNRIs like Duloxetine (Cymbalta) and Venlafaxine (Effexor)?
Hopelessness (enhances norepinephrine effects).
Which medications are activators for treating lack of energy, fatigue, or motor retardation?
Fluoxetine (Prozac), Bupropion (Wellbutrin), Venlafaxine (Effexor).
What medication is often used to treat insomnia?
Fluvoxamine (Luvox), Mirtazapine (Remeron), or TCAs.
What should be considered when treating younger adults with depression?
Fluoxetine (Prozac) is best studied and safest.
Which antidepressant is preferred for older adults?
Citalopram (Celexa), due to fewer anticholinergic effects.
What are the first-line treatments for serotonin deficiency?
SSRIs (Fluoxetine, Sertraline, Paroxetine, Fluvoxamine, Citalopram, Escitalopram) and lower dose Venlafaxine (Effexor).
Which SSRI can help lower A1c in diabetic patients?
Paxil (Paroxetine) can decrease A1c by up to 1.0 but may cause weight gain.
What is an important consideration when selecting an antidepressant?
Symptoms often overlap; expert opinion suggests trying an SSRI first.
What medication is effective for Premenstrual Dysphoric Disorder (PMDD)?
SSRIs
Which medication can decrease cravings in patients with addictions?
Bupropion.
Which TCA is useful for Attention Deficit – Hyperactivity Disorder (ADHD)?
Desipramine, but it may be sedating.
What medication is effective for migraine prophylaxis?
TCAs, specifically amitriptyline (Elavil).
Which medications are best for fibromyalgia and chronic pain syndromes?
TCAs, followed by MAOIs, then SSRIs; SNRIs like desvenlafaxine (Pristiq) and duloxetine (Cymbalta) are also helpful.
What medications can be used for hot flushes during menopause?
Effexor (Venlafaxine) and desvenlafaxine (Pristiq).
What is the safest antidepressant for use during pregnancy?
Desipramine (TCA) and SSRIs, with Prozac being the most studied.
Which SSRIs are preferred during breastfeeding?
Sertraline and Paroxetine, as they have the lowest penetration into breast milk.
In which situations should TCAs be avoided?
Avoid in cardiac arrhythmias, elderly with fall risk, obesity, benign prostatic hypertrophy, urinary retention, and bipolar disorder.
How long should a patient be on a full dose before switching medications?
If there’s no response at full dose, consider switching after 12 weeks.
What should be done for a patient with a partial response to antidepressants?
Add another antidepressant from a different class, avoiding two serotoninergic drugs to prevent serotonin syndrome.
How does folic acid affect antidepressant response?
Optimizing folic acid speeds the response of antidepressants.
Which combinations work well for specific symptoms?
SSRI + Bupropion for activation and focus.
Venlafaxine + Bupropion for apathy and hypersomnia.
Mirtazapine added to an SSRI to reduce serotonergic side effects and aid sleep
what is tachyphylaxis?
refers to a rapid decrease in the response to a drug after repeated doses. This means that a patient may experience a diminished effect from a medication, even if they are taking the same dose. In the context of antidepressants, especially SSRIs, this phenomenon can lead to a relapse of symptoms after an initial positive response.
The exact mechanisms behind tachyphylaxis are not fully understood
