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PHA333 > Wk 27 - Depression > Flashcards

Wk 27 - Depression Flashcards

1
Q

What are the classifications for depression?

A
  • Major depression (unipolar)

- Bipolar (manic)

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2
Q

What are the key symptoms of depression?

A
  • Persistent sadness/low mood

- Marked loss of interest

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3
Q

What are the associated symptoms of depression?

A
  • Disturbed sleep
  • Dec/inc appetite
  • Fatigue
  • Agitation
  • Poor conc
  • Feelings of worthlessness
  • Suicidal thoughts
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4
Q

What are subthreshold depressive symptoms?

A

Fewer than 5 symptoms of depression

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5
Q

What is mild depression?

A

Few symptoms in excess of 5 required to make diagnosis + symptoms result in minor functional impairment

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6
Q

What is moderate depression?

A

Symptoms or functional impairment are btw mild + severe

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7
Q

What is severe depression?

A

Most symptoms + symptoms markedly interfere w/ functioning. Can occur w/ or w/o psychotic symptoms

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8
Q

What is needed for GP active treatment?

A
  • Past fam history
  • No social support
  • Associated social disability
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9
Q

What is needed for a referral to a mental health service?

A
  • Poor or incomplete response to 2 interventions
  • Recurrent episode w/in 1 year
  • Relative referral
  • Self neglect
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10
Q

What is needed for a psychiatric referral?

A
  • Actively suicidal ideas or plans
  • Psychotic symptoms
  • Severe agitation w/ severe symptoms
  • Severe self neglect
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11
Q

Outline the pathophysiology of depression

A
  • Dysregulation of serotonin + NA in brain strongly associated w/ depression
  • Dysregulation in spinal cord = inc pain perception among depressed patients
  • Imbalance = emotional + physical symptoms
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12
Q

Outline the focus + nature of intervention in step 1 of the stepped care model

A
  • Step 1: all known + suspected presentations of depression

- Assessment, support, psycho-education, active monitoring + referral for further assessment

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13
Q

Outline the focus + nature of intervention in step 2 of the stepped care model

A
  • Step 2: persistent subthreshold depressive symptoms; mild to mod depression
  • Low-intensity, psychosocial interventions, psychological interventions, meds + referral for further assessment
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14
Q

Outline the focus + nature of intervention in step 3 of the stepped care model

A
  • Step 3: persistent subthreshold depressive symptoms or mild to mod depression w/ inadequate response to initial interventions; mod + severe depression
  • Med, high intensity psychological interventions, combined treatment, collaborative care + referral for further assessment + interventions
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15
Q

Outline the focus + nature of intervention in step 4 of the stepped care model

A
  • Step 4: severe + complex depression, risk to life, severe self neglect
  • Meds, high intensity psychological interventions, electroconvulsive therapy, crisis service, combined treatments, multi professional + inpatient care
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16
Q

What is an SSRI?

A
  • Safer in OD
  • Don’t stim appetite
  • Fewer antimuscarinic s/e than tricyclics + other NA uptake inhibitors
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17
Q

What are the uses for SSRIs?

A
  • Depression
  • Panic disorder (chronic anxiety + prophylaxis for panic attack)
  • OCD
  • Bulimia nervosa
  • Seasonal affective disorder (esp carb craving + weight gain)
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18
Q

What are the adverse effects of SSRIs?

A
  • GI disturbance
  • Dry mouth
  • Headache
  • Insomnia
  • Dizziness
  • Sweating
  • Erectile dysfunction
  • Delayed orgasm
19
Q

What are the drug interactions of SSRIs?

A
  • TCA (SSRI inc plasma conc)
  • Antiepileptics (inc risk of convulsions)
  • Aspirin, warfarin + NSAIDs (risk bleeding
  • MAOIs (inc risk of serotonin syndrome)
  • Citalopram + Escitalopram prolong QT interval, avoid giving to existing QT interval prolongation (TCA, methadone, antipsychotics + erythromycin)
20
Q

What are the contraindications of SSRIs?

A
  • Hepatic + renal failure
  • Epilepsy
  • Manic phase
21
Q

What is the maximum dose of citalopram?

A
  • Adults: 40mg daily
  • Elderly: 20mg
  • Hepatic impairment: 20mg
22
Q

Outline the important points to remember when taking SSRIs

A
  • 2-4wks for effect
  • Review every 1-2 wks for at least 4 wks
  • Continue for at least 6 months
  • Recurrent depression patient - 2 years
  • W/drawal slow
23
Q

What are the uses of TCAs?

A
  • Depressive illness
  • Atypical oral + facial pain
  • Prophylaxis of panic attack
  • Phobia anxiety
  • OCD
  • Nocturnal enuresis
24
Q

What are the adverse effects of TCAs?

A
  • Arrhythmias
  • Anxiety
  • Dizziness
  • Dry mouth
  • Urinary retention
  • Hyponatremia in elderly (sodium deficient)
25
Q

What are the drug interactions of TCAs?

A
  • MAOI (risk of hypertensive crisis + hyperpyrexia)
  • Antiepileptics (red seizure threshold)
  • Alcohol + antihistamines (inc sedation)
  • Antihistamines + anticholinergic (inc antimuscarinic effect)
26
Q

What are the contraindications of TCAs?

A
  • Recent MI
  • Arrhythmias
  • Epilepsy
  • Mania
  • Severe liver disease
27
Q

Outline the important points to remember when taking TCAs

A
  • OD fatal due to cardiac arrhythmias
  • Symptomatic improvement after 2 wks
  • Vary in sedation: amitriptyline = sedating, imipramine = non-sedating
28
Q

What are the uses of SNRIs?

A

Venlafaxine + duloxetine:

  • Depression
  • Anxiety
  • Panic disorder
  • Pain syndrome: fibromyalgia

Desvenlafaxine:

  • Major depressive disorder
29
Q

What are the adverse effects of SNRIs?

A
  • Inc BP
  • Weight loss
  • Hepatitis
  • GI discomfort
  • Dizziness + headache
30
Q

What is venlafaxine?

A
  • Weak NA/5-HT uptake inhibitor
  • Non-selective
  • S/e similar to SSRI
  • W/drawal effect if dose missed
  • For treatment resistant patients
31
Q

What is duloxetine?

A
  • Potent + non-selective NA/5-HT uptake inhibitor
  • Use: urinary incontinence + diabetic neuropathy
  • S/e: sexual dysfunction, sedation + nausea
32
Q

What is reboxetine?

A
  • NRI
  • Use: depression
  • S/e similar to TCA
  • Safe in OD
  • Low risk of cardiac dysrhythmias
33
Q

What is St John’s wort?

A
  • Weak NA/5-HT uptake inhibitor
  • Non-selective
  • Use: depression
  • Potent enzyme inducer
  • Interactions: warfarin, theophylline, cyclosporine + oral contraceptives
34
Q

What is mirtazapine?

A
  • Enhance NA + act more rapidly than other antidepressants
  • Cause less nausea + sexual dysfunction than SSRI
  • S/e: sedation, hypotension + cardiac dysrhythmias
35
Q

What is mianserin?

A
  • Risk of bone marrow depression
  • Regular blood count advisable
  • S/e: Dry mouth, sedation + weight gain
36
Q

Give examples of MAOIs

A
  • Moclobemide: depression

- Selegiline + rasagiline: PD

37
Q

What are the uses of MAOIs?

A
  • Depressive illness, alone or combined w/ TCAs
  • Atypical oral depression
  • Phobia anxiety + depression w/ anxiety
38
Q

What are the adverse effects of MAOIs?

A
  • Orthostatic hypotension
  • Weight gain
  • Sexual dysfunction
  • Dizziness
  • Aggravation of migraine
  • Antimuscarinic effect
39
Q

What are the drug interactions of MAOIs?

A
  • Accumulation of amine NT = hypertensive crisis + hyperpyrexia
  • Sympathomimetics (cough + decongestants)
  • SSRI + TCA
  • Levodopa
  • Opioid
  • Tyramine containing food (cheese, beans)
40
Q

What are the contraindications of MAOIs?

A
  • Hepatic dysfunction
  • Epilepsy
  • Pheochromocytoma
  • Cerebrovascular disease
41
Q

What are the important points to remember when taking MAOIs?

A
  • Avoided due to severe s/e
  • W/drawn slowly due physiological dependence + w/drawal syndrome
  • Due to irreversible MAO inhibition, other antidepressants shouldn’t be started for at least 2 wks after stopping
42
Q

What is the choice of antidepressant when on NSAIDs + aspirin?

A

Mirtazapine, trazodone, moclobemide for reboxetine

43
Q

What is the choice of antidepressant when on warfarin or heparin?

A

Mirtazapine

PHA333 (35 decks)

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