Depression Flashcards
(46 cards)
DSM-5 Criteria for major depressive disorder
-5 or more symptoms present during same 2 week period
-At least 1 is depressed moof or loss of pleasure in activities
-Others: wt loss, insomnia or hypersomnia, psychomotor agitation, fatigue, worthlessness, can’t think, suicidal thoughts
BBW
Inc risk of suicidality in young adults 18-24 years old especially at early stages of treatment
First line depression meds
SSRIs, SNRIs, bupropion, mirtazapine, vortioxetine
Depression treatment
-Response: 50% symptom reduction after 4 weeks, AD should be continued at optimal dose and reevaluated at 6, 8 and 12 weeks
-Persist: switch to alternative AD or augmentation w/ AD with an alternative MOA, a SGA or psychotherapy
Selective Serotonin Reuptake Inhibitors (SSRIs)
-discontinuation syndrome (except Prozac)
-abnormal bleeding due to 5-HT reuptake on platelets, hyponatremia, serotonin syndrome, cognitive & motor impairment
-QTc effects from some SSRIs
-More energy boosting than sedating
Serotonergic drugs w/ SSRIs
Triptan migraine agents, pain meds (fentanyl/tramadol), nausea products (zofran, reglan), buspirone, linezoid, ritonavir
SSRI interactions
-QTc prolongation with contaminant meds
-inc risk of bleeding with NSAIDs, anti-platelets, anticoagulants
SSRI pearls
-d/c syndrome (except prozac) - common in Paxil
-abnormal bleeding due to serotonin reuptake on platelets
-hyponatremia
-serotonin syndrome
-cognitive and motor impairment
-QTc effects from some SSRIs
-More energy boosting than sedating
SSRIs AE
Anxiety initially (low dose than titrate), insomnia, HA (initially), hyponatremia & SIADH (rare but serious), monitor for inc lethargy mental status changes & serum Na+ less than 135, may cause sexual dysfunction
Discontinuation syndrome SE
FINISH (flu like symptoms, insomnia, nausea, sensory disturbances, hyper arousal)
Serotonin syndrome (agents that can inc risk)
Triptan migraine agents, pain meds (fentanyl/tramadol), nausea products (zofran, reglan), buspirone, linezolid, ritonavir
Citalopram
-SSRI
-High doses not recommended in elderly
-QTc warning
-ODT available
-Lower doses in hepatic impairment
Escitalopram
-SSRI
-MDD, GAD
-Lower dose in hepatic impairment
-Can use in PEDs 12-17
Paroxetine
-SSRI
-Short half life (discontinuation syndrome)
-Sedating and anticholinergic, so be careful in elderly patients
-Avoid in pregnancy
-Akathisia
-bone fractures have occurred in some patients
Sertraline
-SSRI
-Concentrate can only be mixed with water, ginger ale, lemon/lime soda, lemonade, OJ
-QTc but less than lexapro and celexa
Fluvoxamine
-SSRI
-Caution in elderly - most sedating and anticholinergic
-Many DDI (1A2)
-OCD
Fluoxetine
-SSRI
-Only SSRI approved for once weekly administration
-Inhibits TCAs and CBZ
-Anorexia, anxiety, insomnia
-Combo olanzapine + fluoxetine
SNRI AE
-abnormal bleeding due to serotonin reuptake on platelets
-potential for inc risk of activation of mania
-elevated BP
-hypenatremia
-serotonin syndrome and d/c syndrome
-more energy boosting than other AD
Desvenlafaxine
-SNRI
-3A4 interactions, don’t crush or chew
-hyperlipidemia has been reported
-Eosinophilic pneumonia (d/c)
Venlafaxine
-SNRI
-give with food
-2D6 interactions
-BP changes at higher doses & eosinophilic pneumonia reported
-dose reductions up to 50% for mild-mod hepatic or renal impairment
Duloxetine
-SNRI
-avoid in liver dysfunction or ESRD
-avoid ETOH
-1A2 and 2D6 interaction; do not chew or crush
-hepatotoxicity; severe skin rxns
-urinary retention
-hypotension
-less insomnia potential than other SNRIs
Levomilnacipran
-SNRI
-urinary retention
-inc HR
TCAs
-less commonly used for depression
-Cardiovascular events
-Anticholinergic effects
-CV ventricular tachycardia, heart block, lethal in OD
-Give at bed b/c of sedation
-Cognitive impairment, urinary retention possible
-Can cause: wt gain, sexual dysfunction, drug interaction 2D6, monitor serum conc. for adherence, toxicity, baseline EKG
TCA withdrawal syndrome
-due to abrupt d/c
-symptoms: insomnia, sweating, abdominal pain, diarrhea, myalgias, nausea
