Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

neurology/psychiatry > Depression > Flashcards

Depression Flashcards

(99 cards)

Start Studying
1
Q

DSM-5 criteria for MDD

A

5 symptoms present during the same 2 week period
depressed mood or decreased interest + 4 symptoms from DSIGECAPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DSIGECAPS

A

depressed mood
sleep
interest
guilt
energy
concentration
appetite
psychomotor
suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

onset of MDD

A

most commonly late 20s but can develop at any age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

duration of MDD

A

median time to recovery is 20 weeks with adequate treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

__% of patients with a single episode with recover without recurrence

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what defines a RESPONSE to treatment

A

> 50% reduction in symptom severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what defines REMISSION

A

absence of depressive symptoms (or only 1-2 mild symptoms) for >2 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

goal of acute phase

A

remission
select initial agent based on patient factors, optimize regiment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

goal of continuation phase

A

prevent RELAPSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

goal of maintenance phae

A

prevent RECURRENCE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

monoamine hypothesis

A

depressive symptoms related to deficiencies in 5HT, NE, DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

dysregulation hypothesis

A

depression results from dysregulation of neurotransmitters that leads to alterations in pre & post receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

neuroendocrine hypothesis

A

dysregulation of thyroid & HPA axis results in depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SSRI mechanism

A

inhibit reuptake of 5HT in the presynaptic neuron of CNS–> leading to increased serotonin in synaptic cleft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SSRI place in therapy

A

first line for MDD: well tolerated, low toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SSRI (general) dosing

A

daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

SSRI drugs

A

citalopram
escitalopram
sertraline
paroxetine
fluoxetine
fluvoxamine
vortioxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

COMMON ssri side effects

A

n/v
headache
sleep changes
increased anxiety/agitation or sedation
sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SERIOUS ssri side effects

A

hyponatremia
increased bleeding/bruising
serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

most ACTIVATING ssri

A

fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

most SEDATING ssri

A

paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the “dirty ssri” and why

A

paroxetine: it is anticholinergic and antihistaminic, more sexual dysfunction, most weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which ssri causes the most diarrhea and why

A

sertraline: it can affect serotonin in the gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

which ssris have most QT prolongation risk

A

citalopram
escitalopram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
SNRI mechanism
inhibits the reuptake of serotonin and norepinephrine presynaptically
26
SNRI place in therapy
first/second line for MDD: low toxicity, addition mechanism with NE
27
what are the SNRIs
venlafaxine duloxetine desvenlafaxine levomilnacipran
28
what are common side effects of SNRIs
same as SSRIs PLUS dose-dependent BP elevation, constipation
29
what are serious side effects of SNRIs
hyponatremia, increased bleeding/bruising, serotonin syndrome
30
SARIs
trazodone, nefazodone
31
SARI mechanism
5HT2A and 5HT2C receptor antagonist (post-synaptic) inhibits serotonin reuptake
32
SARI place in therapy
not usually first or second line because too sedating
33
SARI adverse effects
sedation, dizziness, orthostatic hypotension, priapism
34
trazodone is used for
most commonly for insomnia rather than MDD
35
nefazodone boxed warning
liver failure not first line due to this toxicity
36
NDRI mechanism
inhibits reuptake of norepi and dopamine, no serotonin activity
37
NDRI place in therapy
first or second line treatment of MDD
38
NDRI drug
bupropion
39
NDRI side effects
activation (insomnia, agitation, tremor), weight loss, headache, n/v, constipation
40
benefits of NDRI
fatigue, poor concentration, smoking cessation
41
NDRI contraindications
bulimia, anorexia, seizure disorders appetite suppression & lowers seizure threshold
42
what does it mean that NDRI is activating
may exacerbate anxiety, caution in patients with psychotic features
43
NDRI can be used for?
ssri-induced sexual dysfunction, smoking cessation
44
NaSSa
mirtazapine
45
NaSSa mechanism
primary: alpha2 antag secondary: 5HT2, 5HT2C, 5HT3 antagonist, antihistamine
46
mirtazapine place in therapy
considered second line
47
mirtazapine side effects
weight gain and sedation worse at lower doses less sexual dysfunction
48
serotonin modulator
vilazodone
49
vilazodone mechanism
serotonin reuptake inhibitor, 5HT1A partial agonist
50
dosing vilazodone
daily at bedtime with food to inc bioavail
51
which drug has the lowest incidence of sexual dysfunction
vilazodone
52
TCA mechanism
presynaptic inhibition of NE and 5HT reuptake: increase them in synaptic cleft varying affinity for H1, alpha, muscarinic
53
TCA place in therapy
effective but third/fourth line due to toxicity in overdose & overall tolerability
54
which TCAs are tertiary amines
amitriptyline clomipramine doxep8in imipramine
55
which TCAs are secondary amines
amoxapine desipramine nortriptyline
56
what does tertiary amine mean
more anticholinergic, alphalytic, antihistaminergic
57
what does secondary amine mean
more NE reuptake inhibition
58
common TCA side effects
anticholinergic antihistaminergic orthostasis photosensitivity
59
serious TCA side effects
cardiotoxicity: QT prolongation, risk of MI decrease seizure threshold
60
what is the most anticholinergic and alphalytic TCA
amitriptyline
61
what is amitriptyline used for
chronic pain, migraine
62
what is the most serotonergic TCA
clomipramine
63
what is clomipramine used for
OCD
64
what is the most noradrenergic/lowest anticholinergic TCA
desipramine
65
what is the most antihistaminic TCA
doxepin
66
what is imipramine used for
GAD, panic disorder with agoraphobia
67
what is the best tolerated TCA
nortriptyline
68
MAOI mechanism
inhibition of monoamine oxidase enzymes (MAO-A & MAO-B) resulting in increased concentrations of NE, 5HT, DA in synapse
69
common MAOI side effects
hypotension, dizzy, urinary retention, constipation, xerostomia
70
serious MAOI side effects
hypertensive crisis (drug-food interaction) serotonin syndrome (drug-drug interaction)
71
definition of hypertensive crisis
diastolic BP> 120 mmHg
72
symptoms of hypertensive crisis
occipital headache, palpitations, neck stiffness, n/v, dilated pupils/photophobia, tachy/bradycardia, chest pain
73
MAOIs require dietary modifications to prevent food-drug interaction with _____
tyramine
74
foods to avoid with MAOIs
dried, aged, smoked, fermented, spoiled meat/fish broad bean pods aged cheese tap & non-pasteurized beer marmite, sauerkraut soy products/tofu
75
foods allowed with MAOIs
fresh/processed meat veggies processed & cottage cheese, ricotta, yogurt canned/bottled beers brewer's and baker's yeast
76
treatment of hypertensive crisis with MAOIs from tyramine
phentolamine nifedipine, chlorpromazine
77
drug-drug interactions with MAOIs
decongestants (eg sudafed) stimulants (amphetamine, coke) antidepressants w/ NRI (TCA, NRI, SNRI, NDRI) appetite suppressants (phentermine)
78
selegiline pearls
selective for MAO-B no need for dietary restriction w/ patch but drug-drug interactions still a concern
79
phenelzine pearls
weight gain, hepatotoxicity
80
tranylcypromine pearls
similar to amphetamine structurally (stimulating) insomnia transient hypertension
81
serotonin syndrome
agitation, tachycardia, diarrhea, diaphoresis, clonus, tremor, hyperreflexia
82
DDIs causing serotonin syndrome
antidepressants other TCA-like drugs antibiotics (linezolid) appetite suppressants (sibutramine) opioids
83
prevention of serotonin syndrome with MAOIs
allow for a 2 week washout period (5 week after fluoxetine)
84
boxed warning on all antidepressants
suicidality in children/antidepressants up to 24 years old
85
discontinuation syndrome
flu-like, paresthesia
86
drug with most severe discontinuation syndrome
venlafaxine
87
onset of discontinuation syndrome
1-2 days after d/c
88
MDD treatment in pregnancy?
avoid paroxetine
89
postpartum depression treatment?
SSRIs are first line
90
MDD treatment in peds?
SSRIs: fluoxetine, escitalopram, citalopram, sertraline
91
MDD treatment in elderly?
start low and go slow may manifest as cognition changes
92
first line in MDD treatment algorithm
psychotherapy, SSRI, SNRI, mirtazapine, bupropion
93
improvements seen in week 1
decrease anxiety increase sleep, appetite, energy
94
improvements seen in week 2
increase activity, self care, memory, concentration
95
improvements seen in week 3
decreased depression, hopelessness
96
when is full response seen
4-6 weeks
97
what is an adequate trial
6 weeks
98
define treatment resistant depression
failure of at least 2 treatment attempts of adequate dose and duration
99
options for treatment resistant depression
SGA lithium buspirone stimulants esketamine

neurology/psychiatry (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions