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67 Cards in this Set
- Front
- Back
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Depression - Dysthymic disorder definition
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Less severe depression but chronic
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Depression - Difference between major depressive disorder(MDD) and dysthymic disorder
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MDD is more severe(>5 symptoms), dysthymic is less severe(>2 but less than 5) symptoms.
Dysthymic is more chronic (diagnosed over 2 years) and MDD can be more episodic(over 2 weeks) that can reoccur |
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Depression - Some questionaires used to assess depression are ___ (2)
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Patient Health Questionaire (PHQ-9)
Hamilton Depression scale (HAM-D-7) |
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Depression - Non pharmacologic therapy
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- CBT: cognitive behavioral therapy
- IPT: interpersonal therapy - Regular exercise (as adjunctive therapy) - Proper diet |
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Depression - Efficacy of CBT and IPT for depression is (not as good / similar to / better than) pharmacotherapy.
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Similar to.
Useful for mild to moderate depression only. |
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Depression - 5 messages to tell the patients about their medication
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RCT CD:
- Remember that it takes 2-4 weeks for medication to have an effect - Continue to take the medication even if you are feeling better - Take the medication daily. - Call this number if you have concerns about side effects or have any issues - Do not stop taking the medication without first consulting a doctor. |
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Depression - The treatment of dysthymic disorder differs from that of MDD (True/False)
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False.
The treatment for the two are similar. |
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Depression - Minimum therapeutic dosing must be reached within ___ weeks.
If necessary can be increased over ___ to ___ weeks. |
2 weeks
4 to 6 weeks |
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Depression - Side effects of antidepressants usually go away after ___ weeks.
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2 weeks
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Depression - What should you do if side effects become too bothersome however some therapeutic benefit is seen? When?
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Switch to another within same class.
Within 3-8 weeks. |
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Depression - A meta-analysis of 12 antidepressants going head to head revealed which 4 drugs to have superior efficacy?
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EMS V:
Escitalopram Mirtazaprine Sertaline Venlafaxine |
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Depression - Of the four superior antidepressants, taking acceptability into consideration, which 2 were best?
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ES:
Escitalopram Sertraline |
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Depression - What are the characteristic symptoms of depression?
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SIG: E CAPS (Sig: energy capsules)
- Sleep (insomnia or hypersomnia) - Interest - Guilt (excessive, feeling worthless, hopeless) - Energy - Concentration - Appetite (increased or decreased, weight gain or loss 5%) - Psychomotor (retardation or agitation) - Suicidality |
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Depression - Premenstrual Dysphoric Disorder occurs ___ (when)?
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1-2 weeks before their period
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Depression - Post Partum occurs ___ (when)?
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4 weeks after birth
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Depression - Melancholia depression type features ___ (3)
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- Severe depression
- Diurnal variation - Weight loss (significant) |
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Depression - Atypical depression features are ___ (3)
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- Weight gain (significant)
- Hypersomnia - Rejection sensitivity (being extremely hurt at the slightest rebuff, eg being asked to wait a moment) |
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Depression - Response rates of antidepressants are approximately ___ %. Placebo response rate is ___%.
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60-70%
30-35% |
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Depression - SSRIs - Name them (6)
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Effective For Sadness, Panic, & Compulsions:
- Escitalopram - Fluoxetine / Fluvoxamine - Sertraline - Paroxetine - Citalopram |
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Depression - SSRIs have exhibit a flat response curve. What does that mean?
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Higher doses have wont see any more effect.
Majority of depressed patients respond at the lowest effective dose. |
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Depression - SSRIs - Of the SSRIs, which has the longest t1/2?
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Fluoxetine (~75hours)
Norfluoxetine (~160hours) |
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Depression - SSRIs - Which SSRI has the lowest bioavailability?
What can be done to increase it? |
Sertraline
Take with food to increase F by 40%. |
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Depression - SSRIs - Some SSRIs have relatively shorter half lives.
What has to be done? Which ones need it? |
Causes discontinuation syndrome
Paroxetine, Sertraline, Citalopram Must taper off slowly for 4-6 weeks. |
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Depression - SSRIs - Discontinuation Syndrome - What are the symptoms?
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FINISH:
- Flu like symptoms (fatigue, lethargy, muscle ache) - Insomnia - Nausea - Imbalance (Gait, dizziness) - Sensory changes (Paresthesia, Electric shock sensation) - Hyperarousal (Anxiety, Agitation) |
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Depression - SSRIs - Serotonin Syndrome?
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MAN (CNS overstimulation by serotonin):
- Mental status changes (Agitation, Confusion) - Autonomic (Fever, Respiratory, Sweating, BP increases) - Neuromuscular (rigidity, hyperreflexia) |
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Depression - SSRIs - What are the general SE?
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3 S's:
- Sexual dysfunction - Stomach upset (GI symptoms) - Serotonin Syndrome |
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Depression - SSRIs - Which SSRIs at high doses cause QT prolongation? (2)
At what dose? |
Citalopram and Escitalopram
>40mg |
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Depression - SSRIs - SSRIs are generally CI with ___.
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Alcohol. It can potentiate the CNS depressive effect.
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Depression - SSRIs - SSRI's have DIs with mainly what?
What is the result? |
CYP P450 isozymes. They are a p450 inhibitor.
This will cause levels of CYP isozymes to drop, causing a decrease in clearance for drugs such as clozapine, methadone, phenytoin or decrease enzymatic activation of prodrugs such as Tamoxifen, Codeine, or Clopidogrel |
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Depression - SSRIs - The SSRI with the least amounts of DI are ___.
Which is moderate? |
Citalopram and Escitalopram.
Sertraline is moderate. |
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Depression - SSRIs - What factors make SSRIs first line agents? (2)
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- Tolerability is greater
- Ease of dosing (OD) |
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Depression - What is second line treatment?
Why are they not first line? |
TCAs
Tolerability and safety concerns about cardiotoxicity |
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Depression - TCAs - What kind of efficacy do they have?
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Similar to SSRIs : approximately 60-70%
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Depression - TCAs - The most commonly prescribed TCA in depression is ___.
Why? |
Amitripyline
Because it also has sedative and analgesic effects (given at lower dosing 25-50mg OD) |
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Depression - TCAs - SE of TCAs are:
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TCA'S SE:
- Thrombocytopenia - Cardiac (Arrythmia, MI, Stroke) - Anticholinergic (Tachycardia, Urinary retention, Constipation, Dry mouth) - Seizure threshold lowered, - Sexual dysfunction - Extra weight (gain) |
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Depression - TCAs - Name the TCAs (6)
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CIA, DND (department of national defense)
- Clomipramine - Imipramine - Amitriptyline - Desipramine - Nortriptyline - Doxepine |
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Depression - TCAs - One of TCAs is one of the best drugs to treat OCD. Which one is it?
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Clomiprimine
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Depression - TCAs - TCAs are divided into 2 categories:
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Secondary
Tertiary |
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Depression - TCAs - ___ TCAs have greater affinity for alpha, H1 and muscarinic receptors.
Also, their absorption is (faster/slower) |
Tertiary
Faster |
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Depression - TCAs - Which TCAs are tertiary?
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CIA is tertiary (Clomipramine, Imipramine, Amitripyline)
and also Doxepine |
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Depression - TCAs - MOA:
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SNRIs.
Block serotonin and norepinephrine transporters, therefore increasing levels. |
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Depression - TCAs - Secondary TCAs are better tolerated than tertiary TCAs (True/False)
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True.
They have less dry mouth, dizziness and weight gain. |
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Depression - TCAs - TCA overdose can be fatal (True/False)
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True (over 2 grams is fatal)
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Depression - Other 1st Line agents (atypical) -
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Mcdonalds Big Mac DVT:
- Moclobemide - Buproprion - Mirtazaprine - Desvenlafaxine - Venlafaxine - Trazodone |
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Depression - Other 1st Line agents (atypical) - Trazodone MOA.
SE? |
Some consider it a SSRI/Hypnotic
SHOP'D: - Sedation - Headache - Orthostatic hypotension - Priaprism - Dizziness |
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Depression - Other 1st Line agents (atypical) - Venlafaxine MOA.
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SNRI(also dopamine)
Considered a "clean" TCA. |
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Depression - Other 1st Line agents (atypical) - Venlafaxine SE
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SHAT
- Similar SE to SSRIs (but no sexual dysfunction) plus: - Hypertension - Adrenergic effects (awake [insomnia], agitated, anxious) - Tachycardia |
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Depression - SNRIs - What are the general SE?
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SHAT:
- Similar SE to SSRIs plus: - Hypertension - Adrenergic effects (awake [insomnia], agitated, anxious) - Tachycardia |
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Depression = SNRIs - Name them (3)
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Vexed & Depressed:
- Venlafaxine - Desvenlafaxin - Duloxetine |
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Depression - Other 1st Line agents (atypical) - Mirtazapine MOA?
SE? |
NaSSA - noradrenaline & specific serotonin antidepressant.
Presynaptic alpha 2 adrenoreceptor antagonist. Weight gain! Dry mouth and sedation. |
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Depression - Other 1st Line agents (atypical) - Duloxetine MOA?
SE? |
SNRI(also dopamine)
SHAT (as above) |
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Depression - Other 1st Line agents (atypical) - Buproprion MOA?
SE? |
NDRI - Norepinephrine and Dopamine reuptake inhibitor
Anxiety, Insomnia, Headaches, GI |
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Depression - MAOIs are ___ line.
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3rd line.
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Depression - RIMA stands for ___.
An example of a RIMA is ___. |
Reversible Inhibitor of Monoamine oxidase A.
Moclobemide |
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Depression - MAOI - name them (2)
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Phenelzine
Tranylcypromine |
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Depression - MAOI - Must caution patient to ___.
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Eat a tyramine free diet.
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Depression - Moclobemide is a first line agent (True/False)
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True
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Depression - Moclobemide also requires a tyramine free diet. (True/False)
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False
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Depression - MAOIs are reserved only for treatment resistant depression (True/False)
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True
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Depression - St John's Wort is thought to be a ____. It prevents reuptake of ___ and ___.
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MAOI.
Norepinephrine and Serotonin |
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Depression - ___ is an essential compound concentrated in the liver and brain. It is involved in pathways leading to an increase in neurotransmitters.
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SAMe
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Depression - For pediatrics it was found that antidepressants were ____.
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Less effective
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Depression - ___ are 1st line in pregnancy
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SSRIs
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Depression - Fluoxetine washout period is ___.
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5 weeks
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Depression - All other SSRIs, the washout period is ___.
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2 weeks
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Depression - TCAs and atypical antidepressants require ___ as a washout period.
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4-5 half lives
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Depression - Treatment of an acute phase is how long?
Continuation phase? |
6-8 weeks
5-9 months |
