Antidepressants (Fluoxetine)

Question 1

Length of antidepressant treatment for 1st time depressed

Answer 1

6 months- 1 year

Question 2

Length of antidepressant treatment for 2nd time depressed

Answer 2

2 years
(70% chance of relapse)

Question 3

Length of antidepressant treatment for 3rd+ time depressed

Answer 3

Lifetime

>90% chance of relapse

Question 4

Response rate of antidepressants

Answer 4

50-65%

Question 5

Remission rate with antidepressants

Answer 5

30-40%

Question 6

What side effect do ALL antidepressants have

Answer 6

Lower seizure threshold

SSRIs, SNRIs, bupropion can trigger a first time seizure in some patients

Question 7

Black box warning for ALL antidepressants

Answer 7

Suicidal thoughts/ behaviors in children, adolescents, young adults (up to age 24)

(monitor weekly for first month, every two weeks for second month, then again in one month)

Question 8

When is suicide risk the highest with use of antidepressants

Answer 8

First 9 days of treatment and with higher starting doses

Question 9

Withdrawal symptoms most associated with which antidepressants

Answer 9

Short half-life antidepressants

Question 10

Withdrawal symptoms from which antidepressants may include cholinergic side effects

Answer 10

TCAs

Question 11

To diagnose MDD, depressive symptoms must be present for how long

Answer 11

≥ 2 weeks

depressed mood OR loss of interest/ pleasure PLUS ≥ 4 SIGECAPS sxs

Question 12

What does SIGECAPS stand for

Answer 12

Suicide
Interests
Guilt
Energy
Concentration
Appetite
Psychomotor
Sleep/ sex

Question 13

Recurrence rate of MDD 1 year after 1st episode?

Recurrence rate of MDD 1 year after 2nd episode?

Answer 13

1st episode- 25%

2nd episode- 41%

Question 14

Recurrence rate of MDD 2 years after 1st episode?

Recurrence rate of MDD 2 years after 2nd episode?

Answer 14

1st episode- 42%

2nd episode- 59%

Question 15

Recurrence rate of MDD 5 years after 1st episode?

Recurrence rate of MDD 5 years after 2nd episode?

Answer 15

1st episode- 60%

2nd episode- 74%

Question 16

What 3 things does serotonin regulate

Answer 16

Mood, emotions, feeding behavior

Question 17

How do SSRIs increase levels of serotonin

Answer 17

Binding/ inhibition of SERTs (serotonin reuptake transporters)

Question 18

What liver enzymes are inhibited by Fluoxetine

Answer 18

Cytochrome P450

when combined with drugs that are metabolized by cytochrome P450 enzymes, reduced rate of elimination and build-up

Question 19

What is the active metabolite of Fluoxetine

Answer 19

Norfluoxetine

Question 20

What is the half life of the active metabolite of Fluoxetine (Norfluoxetine)

Answer 20

2 weeks

Question 21

What is the half life of the parent drug (Fluoxetine)

Answer 21

2-3 days

Question 22

What are the indications of Fluoxetine (7)

Answer 22

MDD, bipolar depression (w/ olanzapine), bulimia, OCD, panic disorder, PMDD, treatment resistant depression

Question 23

Dose availability of Fluoxetine

Answer 23

10, 20, 40 mg

Question 24

Usual dose of Fluoxetine for depression/ anxiety

Answer 24

20-80 mg

Question 25

Usual dose of Fluoxetine for bulimia

Answer 25

60-80 mg

Question 26

Starting dose of Fluoxetine

Answer 26

10-20 mg QD | or lower @ 5-10 mg in patients with anxiety who are more sensitive to overstimulation effects

Question 27

Time to onset of Fluoxetine

Answer 27

2-4 weeks (slow acting because it takes time for serotonin to accumulate within synaptic cleft) (if no effect in 6-8 weeks, may require dosage increase or may not be effective at all)

Question 28

Once symptoms are gone, continue treating with Fluoxetine for how long

Answer 28

1 year for 1st episode | Indefinite for 2nd+ episodes

Question 29

Max dose of Fluoxetine

Answer 29

80 mg

Question 30

Major side effects of Fluoxetine (13)

Answer 30

``` Sexual dysfunction N/D Anorexia Anxiety Nervousness Drowsiness Fatigue Insomnia HA Tremor SIADH Suicidal ideation (esp if 18-24 yo) Serotonin syndrome ```

Question 31

How can increasing serotonin cause emotional flattening, cognitive slowing, apathy

Answer 31

Diminished dopamine release

Question 32

What side effects are not expected with Fluoxetine

Answer 32

Weight gain, sedation

Question 33

Contraindications of Fluoxetine (4)

Answer 33

MAOI use, bipolar, 1st gen anti-psychotic use, pregnant/ nursing