Depression- 18D

Question 1

Define features of MIRTAZAPINE

Answer 1

• alpha-1 antagonism: orthostasis
• alpha-2 antagonism: anti-depressant effect
• AGRANULOCYTOSIS/NEUTROPENIA

Question 2

Name the secondary TCA’s

Answer 2

• Nortryptilline
• Desipramine (most norandrenergic)
• selective
• fewer side effects

Question 3

Name the irreversible, NON-SELECTIVE MAOI’s

Answer 3

• Phenelzine (sedating)
• Tranylcypromine (activating)
• Isocarboxazid
• side effects: HYPOTENSION

Question 4

Discuss the SELECTIVE MAOI

Answer 4

• selective for MAO-B
• SELEGELINE
• EMSAM Patch
• at low doses, diet modifications not necessary

Question 5

Indications for ECT

Answer 5

• Depression
• mania, including pregancy
• Psychosis
• Parkinsonism, NMS, epilepsy

Question 6

Contraindications to ECT

Answer 6

-there NO ABSOLUTE CONTRA-INDICATIONS TO ECT
-risks fall into three categories
cardiovascular side effects
CNS
pulmonary side effects

Question 7

Maintenance treatment after ECT

Answer 7

• Nortriptyline + Lithium

- maintenance ECT

Question 8

Causes of prolonged apnea in ECT

Answer 8

• pseudocholinesterase deficiency therefore decreased rate of metabolism of succinlycholine
• use ROCURONIUM instead
• treat with continued positive ventilation

Question 9

Rates of death from ECT

Answer 9

1/10,000 - 1/50,000

Question 10

Usual causes of death from ECT

Answer 10

• cardiac complications

- large fluctuations between sympathetic and parasympathetic discharge