- Presistent feeling of hopelessness, dejection, constant worry, poor concentration, lack of energy, sleep problems and sometimes suicidal tendencies

Depression Flashcards by Emily Byford

What is Depression?

Presistent feeling of hopelessness, dejection, constant worry, poor concentration, lack of energy, sleep problems and sometimes suicidal tendencies

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What is the cause of depression/

Neurotransmitter imbalences of serotonin, norepi, epi, dopamine, glutamate, acetylcholine
Serotonin being the more important one

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What is the way we diagnosis depression?

DSM-5
HAM-D

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What is the DSM-5 Criteria for Depression diagnosis?

M SIG E CAPS

Mood - depressed
Sleep - increased or decreased
Interest - decreased
Guilty or worthless feeling
Energy - decreased
Concentration - decreased
Appetite - increased or deacreased
Psychomotor agitation
Sucidial thoughts

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What are some ADHD Medications that could worse depression?

Atomoxetine (strattera)

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What are some Analgesics Medications that could worse depression?

Indomethacin

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What are some Antiretrovirals (NNRTIs) Medications that could worse depression?

Efavirenz (in Atripla)
Rilpivirine (in Complera, Odefsey)

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What are some Cardiovascular Medications that could worse depression?

Beta-blockers (mainly propranlol)

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What are some Hormone Medications that could worse depression?

Contraceptives
Anabolic steroids

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What are some other important Medications that could worse depression?

Antidepressants?
Benzos
Systemic steroids
Interferons
Varenicline
Ethanol

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What are some natural products that can help with depression?

St Johns Wort, 5-HTP, Valerian

becareful for serotonin syndrome

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What is the recommended treatment for someone experiencing depression in pregnancy and postpartum depression?

Psychotherapy is 1st line
SSRIs (citalopram or sertaline] are best if needing a medication

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What aer some boxed warnings to keep in mind about ALL antidepressants?

increased suicidal thoughs in some kids, teens or yound adults
MedGuides ARE required

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What is the lag effects for the antidepressants/

Must be used daily and will take time to work [1-2 weeks to a month]

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What are the drug classes that are used for depression?

SSRIs
SNRIs
Tricyclics (TCAs)
Bupropion (Dopamine/Norepi reuptake inhibitor)
MAOi
Mirtazapine
Trazadone

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What is the MOA for the SSRIs?

Increases serotonin levels by inhibiting the reuptake in the synapse

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What are the SSRIs that are used for depression?

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)

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What are some contraindations for the SSRIs used in depression?

DO NOT use with MAOi or Linezolid
Brisdelle (Paroxitine): DO NOT use in pregnancy

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What are some warnings for the SSRIs used in depression?

Study These Flashcards

QTc Prolongation (DO NOT exceed 20 mg/day Celexa and 10 mg/day Lexapro)
Hyponatremia, Fall Risk
Bleeding (caution with Anticoags, antiplates, NSAIDs)

What are some side effects for the SSRIs used in depression?

Study These Flashcards

Sexual Side Effects (decreased Libido, ejaculation difficulites, ED)
Somnolence, insomnia, Nausea, Dry Mouth, Diaphoresis, Weakness, Tremor, Dizziness, Headache

Because of the serotonin

Prozac - most ACTIVITING; Paxil - most SEDATING

What is the MOA for the SNRIs?

Study These Flashcards

Increases serotonin and norepi levels by inhibiting the reuptake in the synapse

What are the SNRIs that are used for Depression?

Study These Flashcards

Venlafaxine (Effexor XR)
Duloxtine (Cymbalta)
Desvenlafaxine (Pristiq)

Effexor - GAD, Panic Disorders, Social Anxiety
Cymbalta - Neuro pain, GAD, Chornic muscle pain

What are the contraindications for SNRIs?

Study These Flashcards

SNRIs and MAOi have a potentally lethal interaction

What are the warnings for the SNRIs?

Study These Flashcards

Hyponatermia, Falls
Bleeding

Same as SSRIs

What are the **side effects** for the **SNRIs**?

- Sexual Side Effects (decreased Libido, ejaculation difficulites, ED) - Somnolence, insomnia, Nausea, Dry Mouth, Diaphoresis, Weakness, Tremor, Dizziness, Headache (because of Serotonin) - Increased HR, dilated pupils, dry mouth, excessive sweating, constipation (becuase of Norepi)

What is the **MOA** for the **TCAs**?

- Primarily inhibit Norepi and Serotonin BUT also **block ACh and Histamine receptors**

What are the **Secondary and Tertiary Amine TCAs** used for **Depression**?

- Tertiary: Amitriptylline, Doxepin - Secondary: Nortriptylline (Pramelor) ## Footnote Tertiary: more effective BUT have worst side effects Secondary: more selective to Norepi receptors

What are the **contraindications** for the **TCAs**?

- DO NOT use with MAOi, Linezolid, IV Methylene Blue

What are the **Cardiotoxicity side effects** for the **TCAs** used for **Depression**?

- **QTc Prolongations** with Overdose (montior suicidal thoughts as overdose = fatal arrhythmias)

What are the **anticholinergic side effects** for the **TCAs** used for **Depression**?

- Dry mouth, blurred vision, urinary retention, constipation - Weight Gain, Falls

What is the **MOA** for the **Monoamine Oxidase Inhibitors (MAOi)**?

- Inhibits **monoamune oxidase**, which breaks down catecholamines (serotonin, epi, norepi, dopamine)

What are the **MAOi** that are used for **depression**?

- Isocarboxazid (Marplan) - Phenelzine (Nardil) - Tranylcypromine (Parnate)

What are the **warnings** for the **MAOi**?

- Drug-Drug & Drug-Food interactions that could be fatal - **Hypertensive Crisis & Serotonin Syndrome**

What are some of the **miscellaneous drugs** that could be used for **depression**/.

- Mirtazapine (Remeron) - Tradodone (mostly for sleep) - Nefazodone (Rarely used)

What are the **side effects** for **mirtazapine**?

- Sedation - Increased Appetite - Weight Gain

What are the **Side effects** for **trazodone**?

- Sedation (why its used for sleep)

What is the **Boxed warning** for **Nefazodone**?

- Hepatotoxicity (why its rarely used)

what is **treatment-resistant depression**?

- Those that do not respond to **two full** treatment trails

What should one do if they are **not improving or have an incomplete response** should consider?

- Changing antidepressants - Increase the dose - Augment with Buspirone or low dose atypical

what are the **select adjunctive therapy** in **treatment resistant depression** drug classes?

- Antipsychotics (atypicals) - NMDA Receptor Antagonist

What are the **antipsychotics** that are used for **treatment resistant depression**?

- Aripiprazole (Abilify) - Quetiapine (Seroquel)

What are the **Boxed warnings** for the **antipsychotics**?

- eldery patient siwth dementia related psychosis are at increased risk of death

What are the **contraindications** for the **antipsychotics**?

- Olanzapine/fluoxetine: DO NOT use with MAOi, Linezolid, IV Methylene blue (QTc Prolongation)

What are the **side effects** for **aripiprazole**?

- Anxiety, insomnia, akathisia

What are the **side effects** for **Quetiapine**?

- Sedation, Orthostasis, weight gain, increased lipids, increased glucose

Depression Flashcards

(45 cards)