Unit 3-4: Prescribing for Depressive Disorders

Question 1

Which drug classes are preferred for individuals with Major Depressive Disorder (MDD) with no comorbidities?

Answer 1

Any SSRI or SNRI.

Question 2

Which SSRIs are marginally preferred due to their low side-effect profile?

Answer 2

Sertraline (Zoloft) and Escitalopram (Cipralex).

Question 3

What symptoms are best treated with SNRIs like Duloxetine (Cymbalta) and Venlafaxine (Effexor)?

Answer 3

Hopelessness (enhances norepinephrine effects).

Question 4

Which medications are activators for treating lack of energy, fatigue, or motor retardation?

Answer 4

Fluoxetine (Prozac), Bupropion (Wellbutrin), Venlafaxine (Effexor).

Question 5

What medication is often used to treat insomnia?

Answer 5

Fluvoxamine (Luvox), Mirtazapine (Remeron), or TCAs.

Question 6

What should be considered when treating younger adults with depression?

Answer 6

Fluoxetine (Prozac) is best studied and safest.

Question 7

Which antidepressant is preferred for older adults?

Answer 7

Citalopram (Celexa), due to fewer anticholinergic effects.

Question 8

What are the first-line treatments for serotonin deficiency?

Answer 8

SSRIs (Fluoxetine, Sertraline, Paroxetine, Fluvoxamine, Citalopram, Escitalopram) and lower dose Venlafaxine (Effexor).

Question 9

Which SSRI can help lower A1c in diabetic patients?

Answer 9

Paxil (Paroxetine) can decrease A1c by up to 1.0 but may cause weight gain.

Question 9

What is an important consideration when selecting an antidepressant?

Answer 9

Symptoms often overlap; expert opinion suggests trying an SSRI first.

Question 9

What medication is effective for Premenstrual Dysphoric Disorder (PMDD)?

Answer 9

SSRIs

Question 10

Which medication can decrease cravings in patients with addictions?

Answer 10

Bupropion.

Question 11

Which TCA is useful for Attention Deficit – Hyperactivity Disorder (ADHD)?

Answer 11

Desipramine, but it may be sedating.

Question 12

What medication is effective for migraine prophylaxis?

Answer 12

TCAs, specifically amitriptyline (Elavil).

Question 13

Which medications are best for fibromyalgia and chronic pain syndromes?

Answer 13

TCAs, followed by MAOIs, then SSRIs; SNRIs like desvenlafaxine (Pristiq) and duloxetine (Cymbalta) are also helpful.

Question 14

What medications can be used for hot flushes during menopause?

Answer 14

Effexor (Venlafaxine) and desvenlafaxine (Pristiq).

Question 15

What is the safest antidepressant for use during pregnancy?

Answer 15

Desipramine (TCA) and SSRIs, with Prozac being the most studied.

Question 16

Which SSRIs are preferred during breastfeeding?

Answer 16

Sertraline and Paroxetine, as they have the lowest penetration into breast milk.

Question 17

In which situations should TCAs be avoided?

Answer 17

Avoid in cardiac arrhythmias, elderly with fall risk, obesity, benign prostatic hypertrophy, urinary retention, and bipolar disorder.

Question 18

How long should a patient be on a full dose before switching medications?

Answer 18

If there’s no response at full dose, consider switching after 12 weeks.

Question 19

What should be done for a patient with a partial response to antidepressants?

Answer 19

Add another antidepressant from a different class, avoiding two serotoninergic drugs to prevent serotonin syndrome.

Question 20

How does folic acid affect antidepressant response?

Answer 20

Optimizing folic acid speeds the response of antidepressants.

Question 21

Which combinations work well for specific symptoms?

Answer 21

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

Question 22

what is tachyphylaxis?

Answer 22

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

Question 23

Which antidepressants have the lowest profile for tachyphylaxis?

Answer 23

Tricyclic antidepressants (TCAs).

Question 24

Which class of antidepressants is considered to have the highest incidence of tachyphylaxis?

Answer 24

SSRIs

Question 25

What is the first step in managing suspected SSRI tachyphylaxis?

Answer 25

Increase the dose of the SSRI; as long as non-adherence is ruled out

Question 26

How long do SSRI discontinuance symptoms typically last?

Answer 26

They last about 1 to 2 weeks, but some individuals may experience symptoms for 2 months to a year.

Question 26

What is SSRI Discontinuance Syndrome?

Answer 26

A set of withdrawal symptoms that occur after abrupt cessation of an SSRI, especially those with shorter half-lives or after long-term use.

Question 27

Which drug is more likely to cause discontinuance symptoms?

Citalopram
Fluvoxamine
Sertraline
Paroxetine

Answer 27

Paroxetine

Question 27

When do symptoms of SSRI discontinuance typically begin after stopping the medication?

Answer 27

within 2-5 days

Question 28

Common discontinuance symptoms include:

Answer 28

dizziness and nausea

Question 29

Strategies to deal with SSRI discontinuance syndrome include:

Answer 29

1. start a long-acting benzodiazepine when stopping the SSRI.
2. reassure the patient that the symptoms will most likely resolve in 2 to 4 weeks.
3. restart the medication

Question 30

The triad of signs and symptoms of serotonin syndrome includes:

Answer 30

the autonomic nervous system.
mental status (central nervous system).
neuromuscular system.

Question 31

Serotonin syndrome is caused by the following factors:

Answer 31

increased serotonin release.
increased intake of a serotonin precursor.
decreased in serotonin breakdown.

Question 32

TRUE OR FALSE: The combination treatment of an SSRI with another anti-depressant can cause serotonin syndrome.

Answer 32

TRUE

Question 33

Mild serotonin syndrome can be treated by:

Answer 33

withholding the agent in question and providing supportive care.

Question 34

Prevention of Serotonin Syndrome includes:

Answer 34

patient education and rational prescribing practices.