Depression

Question 1

Risk of reoccurance

Answer 1

Episode 1: 50-60%

Episode 2: 70%

Episode 3: 90%

Question 2

Diagnosis

Answer 2

> or equal 5 with at least 1 being depressed or loss of interest

Question 3

SIGE CAPS

Answer 3

Sleep, intertest decrease, guilt/worthlessness, energy loss, concentration difficulties, appetite loss, psychomotor agitation, suicidal ideation

Question 4

Physiological

Answer 4

sleep, appetite, fatigue, clumsiness

Question 5

Phycological

Answer 5

dysphoric mood, loss of interest, guilt, worthlessness

Question 6

Cognitive

Answer 6

concentration difficulties, suicidal ideation

Question 7

Biogenic amine

Answer 7

Reserpine causes depression by depleting NE and 5-HT from vesicles

NE and 5-HT are effective in depression

Genetic polymorphisms in SERT

Alterations in 5-HT1A/C and alpha 2 receptors

Question 8

Neuroendocrine

Answer 8

Alterations in Hypothalamic-pituritary-adrenal axis (HPA)

Overactivity of the axis that causes increased activity of CRF

CRF1:arousal, anxiety, disruption in sex and sleep

Question 9

Neurotropic

Answer 9

Depression, stress and pain patients have decreased BDNF levels

Loss of sprouts and hippocampal volume leads to depression

Antidepressant increase BDNF levels and hippocampal volume

Question 10

MAO-I

Answer 10

MAO normally degrades NE and 5-HT

MAO-A: NE AND 5-HT
MAO-B: DA

Inhibition: increased amount of NE and 5-HT in vesicles released in synapse

Question 11

Phenelzine and Tranylcypromine

Answer 11

drug resistant depression

Non-selective (irreversible)

Question 12

Moclobemide

Answer 12

MAO-A selective (reversible)

Question 13

Selegiline

Answer 13

MAO-B selective (reversible)

Question 14

SE of MAO-I

Answer 14

HA, drowsiness, dry mouth, weight gain, orthostatic hypotension, sexual dysfunction

Hypertensive crisis: AVOID TYRAMINE

MAO normally degrades tyramine

Except selegiline 6 mg/24hr patch

Risk of serotonin syndrome: TCA, SSRI, L-DOPA

MUST HAVE 2 WEEK WASHOUT PERIOD BEFORE SWITCHING ANTIDEPRESSANT (5 WEEKS FOR FLUOXETINE)

Question 15

TCA

Answer 15

Tertiary amines

Block SERT, NET, histamine 1, muscarinic, alpha -1

Question 16

Imipramine

Answer 16

tertiary amine

metabolized to desipramine

Question 17

Trimipramine

Answer 17

tertiary amine

Question 18

Clomipramine

Answer 18

tertiary amine

causes orgasm when yawning

Question 19

Amitriptyline

Answer 19

metabolized to nortriptyline

Question 20

Doxepin

Answer 20

tertiary amine

Question 21

SE of TCA tertiary amines

Answer 21

sedation, confusion, reduced seizure threshold

anticholinergic

orthostatic hypotension, tachycardia

weight gain, sexual dysfunction

Question 22

MOA of TCA secondary amines

Answer 22

blocks NET and SERT

Question 23

Desipramine

Answer 23

secondary amine

Question 24

Nortriptyline

Answer 24

secondary amine

Question 25

Maprotiline

Answer 25

secondary amine

Question 26

SE of TCA secondary amines

Answer 26

less side effects

Question 27

SSRI MOA

Answer 27

inhibit SERT that increases amount of 5-HT in synapse

Question 28

Fluoxetine

Answer 28

take in the morning little sedation, autonomic weight loss long t1/2 activating potential

Question 29

Paroxetine

Answer 29

take at bedtime sedation, weight gain Must taper due to ANTICHOLINERGIC EFFECTS Septal wall defect risk in fetus-->caution in pregnancy

Question 30

Citalopram

Answer 30

QTc prolongation

Question 31

Escitalopram

Question 32

Sertraline

Answer 32

GI upset

Question 33

Fluvoxamine

Question 34

Vilazodone

Answer 34

SSRI +5-HT1A partial agonist Reduce sexual dysfunction effects of SSRI Take with food: nausea and increases bioavailability Cannot be used with SSRI/SNRI

Question 35

Vortioxetine

Answer 35

SSRI + 5-HT1A partial agonist Reduces sexual dysfunction Nausea, vomiting, constipation Cannot be used with SSRI/SNRI

Question 36

SSRI Side effects

Answer 36

Headache, N/V, sexual dysfunction, insomnia, tremor, anxiety, increased bleeding risk, hyponatremia, decreased bone density

Question 37

Withdrawal from SSRI

Answer 37

brain zaps, vertigo, dizziness, sweating, insomnia, confusion SLOW TAPER (10-25%) 1-2 WEEKS

Question 38

Serotonin syndrome symptoms

Answer 38

hyperthermia, muscle rigidity, restlessness, myoclonus, hyperreflexia, sweating, shivery, seizures

Question 39

Serotonin syndrome treatment

Answer 39

d/c treatment and manage symptoms serotonin antagonists BZD to manage myoclonus

Question 40

MOA of SNRI

Answer 40

Blocks NET and SERT

Question 41

Venlafaxine

Answer 41

>150mg/day to have NE effects

Question 42

Desvenlafaxine

Answer 42

active metabolite of venlafaxine nausea (50%) No CYP interactions

Question 43

Duloxetine

Answer 43

Nausea Hepatotoxicity baseline LFT every 6 months

Question 44

Maprotiline

Answer 44

blocks NET

Question 45

Mirtazapine

Answer 45

5-HT2/3, H1, Alpha 2 antagonist Sedation, weight gain Agranulocytosis Increase cholesterol can be taken with SSRI/SNRI

Question 46

Bupropion XL

Answer 46

Blocks NET, DAT Stimulating--> insomnia, appetite suppression CI in seizures and eating disorders Can be used with SSRI/SNRI

Question 47

Trazodone

Answer 47

5-HT2A antagonist + blocks SERT Sedation Orthostatic hypotension priapism

Question 48

Filbanserin

Answer 48

5-HT2A/C antagonist 5-HT1A agonist RAPID ACTING

Question 49

FDA Approved augmentation agents

Answer 49

Aripiprazole Brexpiprazole Cariprazine Quetiapine

Question 50

Treatment of Postpartum depression

Answer 50

SSRI (Fluoxetine or Paroxetine) SNRI (Venlafaxine)

Question 51

Brexanolone

Answer 51

postpartum depression Allopregnanolone levels are increased during pregnancy-->desensitizes GABA-A receptors After birth, allopregnanolone levels return to normal -->brexanolone resensitizes GABA-A receptors REMS 60 hr infusion