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33 Cards in this Set
- Front
- Back
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common symptoms of depression |
depressed mood and/or anhedonia sad, guilt-ridden, hopelessness nervous, irritable, agitated somatic problems (physical problems) psychosis |
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DMS-IV diagnostic criteria for MDD |
must meet 5 of following criteria with at least 1 being depressed mood or anhedonia: depressed mood, anhedonia, weight loss/gain, insomnia/hyperinsomnia, psychomotor agitation, fatigue or decreased energy, feelings of worthlessness, decreased concentration, recurrent thoughts of death |
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3 general factors related to the pathophysiology of depression |
genetic predisposition, environment influences, biological factors |
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3 neurochemical transmitters thought to be involved in the pathology of depression |
serotonin (5HT) dopamine (DA) norepinephrine (NE) |
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role of monoamine repuptake transporters in the pathology of depression |
responsible for removing NTs from the synapse |
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role of monoamine oxidase in the pathology of depression |
metabolizes monomines leading to decreased NT levels |
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major classifications of medications used to treat depression |
selective serotonin reuptake inhibitors (SSRIs) serotonin norepinephrine reuptake inhibitors (SNRIs) atypical antidepressants tricyclic antidepressants (TCAs) trazodone monoamine oxidase inhibitors (MAOIs) |
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MOA of SSRIs |
inhibit serotonin transporter |
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MOA of SNRIs |
inhibit neuronal repute of serotonin and norepinephrine |
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MOA of buproprion |
inhibition of dopamine and norepinephrine reuptake |
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MOA of mirtazapine |
enhances norephinephrine and serotonin activity |
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MOA of tricyclics |
inhibition of norepinephrine and serotonin reuptake |
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MOA of trazodone |
enhances serotonin activity |
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MOA of monoamine oxidase inhibitors |
inhibits the enzyme responsible for metabolizing monoamines |
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ADRs of SSRIs |
activation or sedation nausea sleep disturbances sexual side effects weight gain |
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ADRs of SNRIs |
nausea, GI complaints, insomnia, sexual side effects, increased blood pressure, sweating, agitation |
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ADRs of buproprion |
lowers seizure threshold lower incidence of sexual side effects |
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ADRs of mirtazapine |
sedating antihistaminic effect significant weight gain low rate of sexual dysfunction |
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ADRs of tricyclics |
weight gain glucose dysregulation effects of cardiac conduction very sedating dry mouth, dry eyes, constipation, blurred vision orthostasis |
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ADRs of trazodone |
sedation nausea GI upset priapism- erection lasting more than 4 hours |
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ADRs of monoamine oxidase inhibitors |
a lot of side effects extreme hypertension |
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response to treatment |
significant reduction in, but not complete resolution of depressive symptoms |
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remission |
complete resolution of depressive symptoms |
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recovery |
sustained remission of at least 6 months |
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relapse |
return of depressive symptoms within 6 months of achieving remission |
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recurrence |
successive episode of MDD after recovery from initial episode of MDD |
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acute phase of depression treatment |
initial 6-12 weeks of treatment |
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continuation phase of depression treatment |
treatment bridging remission to recovery typically 6-9 months continuation of antidepressant at full therapeutic dosage antidepressant may be discontinued at the conclusion of the continuation phase |
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maintenance phase of depression treatment |
continuation of an antidepressant at full therapeutic dosage for extended periods of time not necessary for all patients may be beneficial in patients at high risk of relapse or recurrence |
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how to manage insomnia due to antidepressants |
reduce caffeine morning dose reduce dose change antidepressant adjunct with a sleep medication |
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how to manage anxiety due to antidepressants |
minimize or avoid caffeine intake reduce dose and titrate gradually beta-blocker (slow heart rate) benzodiazepine (anti-anxiety meds) |
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how to manage nausea due to antidepressants |
start low, titrate dosage up take with food decrease dose change antidepressant |
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how to manage sexual symptoms due to antidepressants |
decrease antidepressant dose switch to another antidepressant add on a medication wait to see if patient builds up a tolerance to the side effect |
