Antidepressants & Mood Stabilizers

Question 1

What are the 5 R’s for Antidepressant Efficacy?

Answer 1

Response - Greater than or equal to 50% reduction in symptoms
Remission - Symptom free (healthy state)
Recovery - 2-6 months of ongoing remission (not cured)
Relapse - return of symptoms after remission before recovery
Recurrence - return of symptoms after recovery

Question 2

What is a partial response in antidepressant therapy?

Answer 2

When you are between 25%-50% reduction of symptoms

Question 3

How long does it take antidepressants to take effect?

Answer 3

3-8 weeks

Question 4

What is the goal of antidepressant therapy?

Answer 4

Remission/Recovery

Question 5

Are antidepressant associated with withdrawal symptoms?

Answer 5

Yes - slow titration down so this does not happen.

Question 6

What is the FINISH mnemonic stand for? These are symptoms of treatment with antidepressants

Answer 6

Flu-like symptoms
Insomnia
Nausea
Imbalance
Sensory disturbances
Hyperarousal

Question 7

What drug is an antidepressant that can also be given for nicotine withdrawal?

Answer 7

Bupropion

Question 8

What drug can be given for Enuresis (involuntary urination)? What class?

Answer 8

Imipramine (TCA)

Question 9

Drug for diabetic neuropathy, fibromyalgia, and chronic pain? What class?

Answer 9

Duloxetine (SNRI)

Question 10

What can be given for stress incontinence?

Answer 10

Duloxetine (SNRI)

Question 11

What is the SSRI that is only given for OCD?

Answer 11

Fluvoxamine

Question 12

Which SSRIs have a little extra function or “little extra kick” as Segars would say?

Answer 12

Vilazodone and Vortioxetine, note that Segars said if we have them on a regular SSRI and they are not quite satisfied can try one of these for a little extra.

Question 13

What are some side effects for SSRIs?

Answer 13

Sexual dysfunction, weight gain, and acute withdrawal symptoms (concern with all categories)

Question 14

What are rare but serious side effects of SSRIs?

Answer 14

QT prolongation
Hyponatremia (SIADH-like)
Serious Side effects include Serotonin syndrome
- sweating, hyperreflexia, akathisia/myoclonus, shivering/tremors

Question 15

What was the most serious side effect of SSRIs? Segars said this would be one the test

Answer 15

Suicidality - explanation was that the patient is so depressed they cant kill themselves but as they take these meds it gives them just enough energy to actually take their life

Question 16

Which drug from the SSRI class has the most drug-drug interactions?

Answer 16

Fluoxetine

Question 17

Which Drug has the least drug-drug interactions?

Answer 17

vortioxetine and escitalopram

Question 18

TCAs block what other receptors?

Answer 18

HAM - histamine (H1), alpha 1 (adrenergic), and muscarinic (cholinergic)

Question 19

What are the side effects of TCAs that block the alpha adrenergic receptors?

Answer 19

tachycardia, orthostatic hypotension, dysrhythmias

Question 20

What are the side effects of TCAs that block the muscarinic?

Answer 20

dry mouth, urinary retention/constipation, blurred vision

Question 21

What are the effects of TCAs that block the histamine receptor?

Answer 21

sedation/fatigue, dizziness/seizures

Question 22

What do we need to remember for the TCAs?

Answer 22

3 - Cs

Coma, Cardiotoxicity, Convulsions

Question 23

Which drug is a SARA and responsible for blocking presynaptic Alpha2 receptors on NE & 5HT as well as blocks post synaptic 5-HT2/3 receptors?

Answer 23

Mirtazapine

Question 24

What are the two SARA drugs that block post synaptic alpha1 and 5HT2 receptors?

Answer 24

Trazodone and Nefazodone

Question 25

Which SARA is highly associated with weight gain?

Answer 25

Mirtazapine

Question 26

Which SARA has the strongest chance for orthostatic hypotension?

Answer 26

Trazadone

Question 27

Which SARA has the strongest chance for CNS sedation?

Answer 27

Trazadone/Mirtazapine

Question 28

What is the major side effect that we need to know for the NDRI bupropion?

Answer 28

Seizures

Question 29

What are the MAOIs?

Answer 29

Selegeline phenelzine Isocarboxazid Tranylcypromine

Question 30

You want to give a patient a selective MAO-B inhibitor to help with parkinsons disease. What medication did you give the patient?

Answer 30

Selegeline

Question 31

What is unique about the medication selegeline?

Answer 31

It is given via a patch

Question 32

What is the major concern of MAOIs and what causes it?

Answer 32

Hypertensive crisis - caused by blocking MAO-A in the GI necessary for tyramine metabolism

Question 33

What are the signs of hypertensive crisis with MAOIs?

Answer 33

headache, sweating, anxiety, tachycardia, chest pain, SOB, confusion, etc... these people need help quick.

Question 34

What are example of foods with tyramine?

Answer 34

just think anything fermented or aged

Question 35

What is the only drug that we know of that is used to treat post partum depression?

Answer 35

Brexanolone

Question 36

What drug is given as a nasal spray and block the NMDA receptor?

Answer 36

Esketamine - remember all ketamines inhibit the NMDA receptor.

Question 37

What is a side effect of giving lithium? (endocrine)

Answer 37

Hypothyroidism (thyroid goiter) and nephrogenic diabetes insipidus.

Question 38

What are the drug interactions we should be concerned about with lithium?

Answer 38

Diuretics, ACEI, NSAIDS

Question 39

Does lithium have a wide or narrow therapeutic index?

Answer 39

Narrow

Question 40

What is an off label use of lithium?

Answer 40

Reduced risk of suicide

Question 41

Which of the mood stabilizers is a major inducer of CYP450?

Answer 41

Carbamazepine