Chapter 62: Depression Flashcards
(105 cards)
Which neurotransmitters are believed to be involved in depression?
Serotonin (5HT), glutamine, acetylcholine (Ach), dopamine (DA), norepinephrine (NE), and epinephrine (Epi).
What is the most widely used depression assessment scale?
Ham-D
How is depression diagnosed per DSM-5 criteria?
At least 5 of the following symptoms during the same 2 week period (must include depressed mood or diminished interest/pleasure): M SIG E CAPS
Mood – depressed, Sleep – increased/decreased, Interest/pleasure – diminished, Guilt or feeling of worthlessness, Energy – decreased, Concentration – decreased, Appetite – increased/decreased, Psychomotor agitation or retardation, Suicidal ideation.
Key drugs that can worsen depression
- Atomoxetine (Strattera)
- Indomethacin
- Efavirenz (in Atripla)
- Rilpivirine (in Complera, Odefsy)
- BB (especially propranolol)
- Hormonal contraceptives
- Anabolic steroids
- Benzodiazepines
- Systemic steroids
- Interferons
- Varenicline
- Ethanol
Why should benzodiazepines not be used alone in depression
They can worsen and/or mask depression and can be problematic in patients with concurrent substance abuse disorders
What natural products may be helpful for treating depression?
St. John’s wort, SAMe or valerian
Of the natural products that can be used for depression, which can increase the risk of serotonin syndrome?
Both St. John’s wort and SAMe
If a drug does not work after a suitable trial of at least ____, treatment should be reassessed.
4-8 weeks
What class/classes of antidepressants should be used for most patients?
SSRI or SNRI
What is the first line treatment for mild to moderate depression during pregnancy?
Psychotherapy
What are the first line medication options for depression in pregnancy?
Sertraline and Escitalopram
Which medication should be avoided in pregnancy due to cardiac effects?
Paroxetine
What class of medications is preferred for postpartum depression?
SSRIs
Name three examples of MAO inhibitors.
- Phenelzine
- Tranylcypromine
- Isocarboxazid
Who are MAO inhibitors restricted for?
Patients unresponsive to other treatments.
When is the risk for serotonin syndrome the most severe?
When an MAOi is administered with another serotonergic medication.
What are the symptoms of serotonin syndrome?
Severe nausea, dizziness, HA, diarrhea, agitation, tachycardia, or hallucinations.
When discontinuing an antidepressant, what is the general guideline?
It must be tapered over several weeks to avoid withdrawal.
Which drug is the exception to the tapering rule when discontinuing an antidepressant?
fluoxetine, which self-tapers because of its long half-life
What do all antidepressants carry a boxed warning of?
A possible increase in suicidal thoughts or actions in some children, teenagers, or young adults within the few months of treatment or when the dose is changed.
What needs to be dispensed with all antidepressants?
MedGuides
How long does it take for physical symptoms such as low energy to improve with antidepressants?
1-2 weeks
How long may psychosocial symptoms, such as low mood, take to improve with antidepressants?
A month or longer
What is the mechanism of action (MOA) of SSRIs?
Increase 5-HT by inhibiting its reuptake in the neuronal synapse
