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32 Cards in this Set
- Front
- Back
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Depression Diagnosis according to DSM-5
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At least 5 of these symptoms during the same 2 week period (*required):
- Depressed mood* - Marked diminished interest/pleasure* - Significant weight loss or gain - Insomnia or hypersomnia - Psychomotor agitation or retardation - Fatigue or loss of energy - Feelings of worthlessness - Diminished ability to concentrate - Recurrent suicidal ideation |
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Antidepressants and Depression
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SSRIs - 1st line therapy
---Paroxetine is Category C (new formulation Brisdelle is Category X**) TCAs - 2nd most likely to be used |
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FDA approved for Post-Traumatic Stress Disorder
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Sertraline
Paroxetine |
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Fluoxetine
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Prozac
SSRI 10-60 mg/d; 90 mg weekly Can cause activation (increased energy) |
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Paroxetine
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Paxil
SSRI IR - 10-60 mg/d CR - 12.5-75 mg/d **(10 mg IR = 12.5 mg CR)** Pregnancy Category D --- Briselle (Category X) |
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Sertraline
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Zoloft
SSRI 50-200 mg/d Often top SSRI choice in cardiac patients |
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Citalopram
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Celexa
SSRI 20-40 mg/d *Don't use > 40 mg/d d/t QT risk* --- caution or avoid in cardiac patients DON'T use in children |
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Escitalopram
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Lexapro
SSRI 10 mg/d (can increase to 20 mg/d) ---**DON'T exceed 20 mg/d d/t QT risk S-enantiomer of citalopram DON'T use in children |
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SSRI Adverse Effects
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Sexual dysfunction
Somnolence, insomnia, nausea, xerostomia, diaphoresis, weakness, tremor, dizziness, HA SIADH, hyponatremia |
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SSRI Info
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BLACK BOX --- increased risk of suicidal thinking and behavior in children, adolescents, and young adults
CONTRA - SSRIs and MAOIs (must wait 2 wks when going from MAOI to SSRI *or* 2 wks when going from SSRI to MAOI ----- Wait 5 weeks if going from fluoxetine to MAOI DON'T initiate w/ linezolid or methylene blue, pimozide or thioridazine DON'T stop suddenly - will withdraw (anxiety, insomnia, flu-like symptoms |
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SSRI Drug Interactions
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Increased bleeding risk w/ anticoags, antiplatelets, NSAIDs, gingko, thrombolytics
Fluoxetine, fluvoxamine, paroxetine - 2D6 inhibitor Decreased effectiveness of tamoxifen |
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Venlafaxine
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Effexor, Effexor XR
SNRI 150-375 mg/d *Different generics; check orange book* |
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Duloxetine
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Cymbalta
SNRI 4-60 mg/d (or 20-30 mg BID) *Good choice if patient has both pain and depression* |
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Desvenlafaxine
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Pristiq
SNRI 50 mg/d; can increase to 100 mg/d |
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SNRI Info
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BLACK BOX - increased risk of suicidal thinking and behavior in children, adolescents, and young adults
CONTRA - MAOIs and SNRIs; wait 2 weeks before switching from one class to the other - DON'T use w/ linezolid or IV methylene blue - DON'T use duloxetine or levomilnaciprin in uncontrolled narrow angle glaucoma |
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Tertiary TCAs
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Amitriptyline
Doxepin Clomipramine Imipramine Trimipramine |
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Secondary TCAs
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Amoxapine
Desipramine Maprotiline Nortriptyline Protriptyline |
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Amitriptyline
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Elavil
Tertiary TCA Depression - 100-150 mg BID Neuropathic pain/migraine - 10-50 mg QHS |
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Doxepin
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Tertiary TCA
Depression - 100-300 mg QD |
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Nortriptyline
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Pamelor
Secondary TCA Depression - 25 mg TID-QID |
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TCA info
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Norepi and 5-HT reuptake inhibitors
BLACK BOX - increased risk of suicidal thinking and behavior in children, adolescents, and young adults Contra - MAOIs (must wait 2 weeks going to or from MAOI); urinary retention; narrow-angle glaucoma SE - QT prolongation w/ overdose; orthostasis; anticholinergic effects, increased fall risk |
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Isocarboxazid
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Marplan
MAOI 20 mg/d, divided - max 40 mg/d |
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Phenelzine
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Nardil
MAOI 15 mg TID - max 60-90 mg/d |
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Tranylcypromine
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Parnate
MAOI 30 mg/d, divided - max 60 mg/d |
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Selegiline transdermal patch
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Emsam (for depression)
MAOI-B selective inhibitor 6 mg patch/d, can increase to 9 or 12 mg/d CONTRA - tyramine rich food and drink while using 9 mg or 12 mg/d patches and for 2 wks after stopping - DON'T use < 18 y/o |
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MAOI Info
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Inhibits the enzyme monoamine oxidase --- prevents metabolism of 5-HT, NE, Epi, and dopamine
BLACK BOX --- increased risk of suicidal thinking and behavior in children, adolescents, and young adults CONTRA - drug-drug and drug-food interactions --- can cause hypertensive crisis SE - anticholinergic effects, orthostasis, sedation, sexual dysfunction |
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MAOI Interactions
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- 2 week washout if going to or from a MAOI and a SSRI, SNRI, or TCA
Contra in drugs that affect epi, NE, 5-HT, or DA Avoid tyramine-rich foods - aged cheese, pickled herring, yeast extract, air-dried meats, sauerkraut, soy sauce, fava beans, red wines, beer |
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Bupropion
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Dopamine and NE reuptake inhibitor
300-450 mg daily (IR-TID, SR-BID, XL-QD) BLACK BOX - suidicial thinking and behavior in <24 y/o Contra - seizure, 450 mg/d of bupropion, bipolar, anorexic, linezolid or IV methylene blue, if d/c'ing alcohol or sedatives SE - anticholinergic effects, tremors/seizures (dose-related) **No sexual dysfunction** |
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Mirtazapine
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Remeron
5-HT inhibitor, Alpha-1 blocker, histamine blocker 15-45 mg QHS BLACK BOX - suicidal risk for < 24 y/o SE - sedation, increased appetite, weight gain |
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Trazodone
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DA and NE reuptake inhibitor
100-150 mg BID BLACK BOX - suicidal risk < 24 y/o SE - *sedation*, sexual dysfunction and risk of priapism, orthostasis *Rarely used as antidepressant d/t sedation; used off-label for sleep - 50-100 mg QHS) |
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Nefazodone
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DA and NE reuptake inhibitor
Rarely used d/t hepatotoxicity |
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Drugs Used For Treatment-Resistant Depression *ONLY*
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Aripiprazole
Olanzapine/fluoxetine Quetiapine XR |
