Depression

Question 1

What is depression characterized by?

Answer 1

Low mood, loss of interest, and loss of pleasure.

Question 2

What are risk factors for depression?

Answer 2

Personal and family history of depressive illness.

Question 3

What defines chronic depression?

Answer 3

Depression that lasts at least two years.

Question 4

What are the aims of treatment for depression?

Answer 4

To improve mood and quality of life and to reduce relapse.

Question 5

What should depressive patients be assessed for?

Answer 5

Risk of suicide and comorbidities.

Question 6

What lifestyle aspects should depressive patients be counselled on?

Answer 6

Importance of sleep hygiene, physical activity, and healthy diet.

Question 7

What are two methods of managing depression?

Answer 7

Antidepressants and CBT.

Question 8

When should patients be referred to mental health services?

Answer 8

If they’re not improving and considering suicide or self-harm risk.

Question 9

How soon should response to treatment be reviewed for all patients?

Answer 9

Two to four weeks after initiation.

Question 10

How soon should suicidal patients be reviewed?

Answer 10

One week later.

Question 11

When are effects of antidepressants typically seen?

Answer 11

Within four weeks of treatment.

Question 12

For how long should antidepressants be continued?

Answer 12

At least six months.

Question 13

How long should patients continue treatment before switching antidepressants?

Answer 13

Four weeks.

Question 14

What should patients be advised about if they abruptly stop antidepressants?

Answer 14

Risks of withdrawal symptoms.

Question 15

What is the first-line treatment for mild depression?

Answer 15

Psychological sessions.

Question 16

When should antidepressants not be offered routinely?

Answer 16

Unless the patient has a preference.

Question 17

Which SSRIs are commonly used for depression?

Answer 17

• Citalopram
• Escitalopram
• Cetraline
• Fluoxetine
• Paroxetine

Question 18

What is St. John’s wort and its recommendation status?

Answer 18

A herbal remedy that can improve mild depression but is not recommended due to serious side effects and drug interactions.

Question 19

What is the first-line treatment for moderate or severe depression?

Answer 19

Combination therapy with individual CBT and antidepressants.

Question 20

What is the safety profile of SSRIs?

Answer 20

They have a good safety profile and are well tolerated.

Question 21

What is vortioxetine used for?

Answer 21

In patients with limited or no response to at least two antidepressants.

Question 22

How long should maintenance therapy for recurrent depression be continued?

Answer 22

For two years.

Question 23

What is the recommended duration for continuing antidepressant therapy in elderly patients?

Answer 23

Six months or 12 months in patients receiving treatment for generalized anxiety disorder.

Question 24

What condition is associated with all antidepressants?

Answer 24

Hyponatremia.

Question 25

What are symptoms of hyponatremia?

Answer 25

* Drowsiness * Confusion * Convulsions

Question 26

What should be monitored in patients taking antidepressants?

Answer 26

Suicidal thoughts, especially with a history of suicidal behavior.

Question 27

What is serotonin syndrome?

Answer 27

An uncommon adverse drug reaction that can be life-threatening.

Question 28

When can serotonin syndrome occur?

Answer 28

After dose change and overdose of serotonin drugs.

Question 29

What are the symptoms of serotonin syndrome?

Answer 29

* Neuromuscular hyperactivity such as tremor and rigidity * Autonomic dysfunction like tachycardia, blood pressure changes, or altered mental state

Question 30

What can insufficient washout period lead to?

Answer 30

Serotonin syndrome, especially if the first drug is an irreversible MAOI.

Question 31

What are SSRIs usually the first option for?

Answer 31

SSRIs are usually the first option as they're better tolerated.

Question 32

Which SSRI is considered the safest for unstable angina or heart failure?

Answer 32

Setraline is the safest for unstable angina or heart failure.

Question 33

How do SSRIs compare to TCAs in terms of sedation and side effects?

Answer 33

SSRIs have less sedating effects and fewer anti-muscarinic and cardiotoxic effects than TCAs.

Question 34

What potential heart risk is associated with citalopram and escitalopram?

Answer 34

Citalopram and escitalopram can lead to QT prolongation.

Question 35

At what age can fluoxetine be used in children?

Answer 35

Fluoxetine can be used in children from five years.

Question 36

What is the withdrawal symptom risk associated with paroxetine?

Answer 36

Paroxetine has a higher withdrawal symptom risk.

Question 37

Is setraline safe to use in patients with angina and heart failure?

Answer 37

Yes, setraline is safe in angina and heart failure.

Question 38

What are the contraindications of SSRIs?

Answer 38

The contraindications of SSRIs are poorly controlled epilepsy and manic phase bipolar.

Question 39

What does the MHRA warning state regarding SSRIs and postpartum hemorrhage?

Answer 39

There is a small risk of postpartum hemorrhage when SSRIs are used a month before delivery.

Question 40

What does the MHRA recommend regarding the use of SSRIs in pregnancy?

Answer 40

Avoid SSRIs in pregnancy until the benefit outweighs the risk.

Question 41

What is the suicide risk associated with SSRIs in certain populations?

Answer 41

The suicide risk increases in harmful outcomes in children and adolescents.

Question 42

What cautions should be considered when prescribing SSRIs?

Answer 42

Cautions include CVD, diabetes, epilepsy, and history of bleeding disorder.

Question 43

What are some withdrawal symptoms of SSRIs?

Answer 43

Withdrawal symptoms include GI disturbances, headaches, anxiety, dizziness, and sleep issues.

Question 44

Ssri and NSAIDS/antiplatelets

Answer 44

Increased bleeding risk

Question 45

SSRIs and phenytoin

Answer 45

Increased toxicity

Question 46

Ssris and antipsychotics, amiodarone, sotalol

Answer 46

QT prolongation

Question 47

SSRI and nsaids, diuretics, carbamezapine

Answer 47

Hyponatremia

Question 48

SSRIs and other antidepressants

Answer 48

High serontonin syndrome

Question 49

What has similar efficacy to TCAs but more likely to be discontinued due to SE

Answer 49

TCAs

Question 50

What is the problem in TCA

Answer 50

Overdose

Question 51

Non sedating tcas

Answer 51

NIL Nortiptyline Imipramine Lofepramine

Question 52

Tca contraindications

Answer 52

Manic phase bipolar Arrythmias CV related

Question 53

SE of tcas

Answer 53

Toxic in overdose Cardiac SE e.g. QT Antimusacrinic SE Seizures

Question 54

Overdose of TCA symptoms

Answer 54

Dry mouth Coma Dilated pupils Urinary retention Convulsions

Question 55

Lofepramine key points

Answer 55

Less SE, less dangerous but more association with hepatotoxicity

Question 56

Imipramine key points

Answer 56

More anrimuscarinic SE

Question 57

Amitriptyline and Dosulepin key points

Answer 57

Effective but dangerous in overdose. Not recommended in depression treatment

Question 58

How many fail to respond to treatment in TCAs

Answer 58

10 to 20%

Question 59

What should doses be like in elderly

Answer 59

Low

Question 60

What is the half life like in TCAs

Answer 60

Long half life so five once daily at night

Question 61

Are TCAs good for treating depression in children

Answer 61

No

Question 62

Tca and lithium

Answer 62

Higher neurotoxicity risk

Question 63

Tcas and maoi

Answer 63

Increased risk of severe toxicity so avoid for 2 weeks after starters MAOI

Question 64

Tca and antimuscarinics

Answer 64

Higher antimuscarinic effects with antimuscarinic drugs, antipsychotics and antihistamines

Question 65

Tcas and ephedrine

Answer 65

Decreases effects of ephedrine

Question 66

Tcas and pseudoephidrine

Answer 66

Increases effects of pseudoephidrine

Question 68

Tcas and bp tablets

Answer 68

Increases risk of hypo

Question 69

Tcas and diuretics or carbamezapine

Answer 69

Hyponatremia

Question 70

Tcas and antipsychotics, theophylline, amiodarone, sotalol, citalopram and corticosteroids

Answer 70

Increased qt prolongation risk

Question 71

Tcas and SSRI, sumatriptan, MAOI, tramadol

Answer 71

Increased serontonin syndrome risk

Question 72

What are MAOIs known for

Answer 72

Dangerous interactions with some foods and drugs and so are reserved for specialists

Question 73

Name some irreversible maoi

Answer 73

Isocarboxazid (hepatotoxicty) Phenelzine (hepatotoxicty) Tranylcypromine (greater stimulant action than above so more likely to cause hypertensive crisis)

Question 74

Reversible maoi

Answer 74

Moclobemide

Question 75

Memory trick for MAOI

Answer 75

Massive hypertension risk = headache Avoid tyrosine rich food Otc meds (Adrenaline etc) = hypertension Other antidepressants - serontonin syndrome Increased suicide risk

Question 76

Withdrawal symptoms of Maoi

Answer 76

Agitation, irritability, ataxia, movement disorders, vivid dreams, hallucinations

Question 77

Maoi and hepatic impairment

Answer 77

Risk of hepatotoxicity

Question 78

Maoi in pregnancy risk

Answer 78

Neonatal malformation

Question 79

Side effects of maoi

Answer 79

Risk of postural hypotension and hypertensive responses

Question 80

When should MAOis be discontinued

Answer 80

Palpitations and frequent headaches

Question 81

What is the risk associated with sympathiomimetics, TCAs, and dopaminergic drugs?

Answer 81

High risk of hypertensive crisis ## Footnote Examples include ephedrine, pseudoephedrine, clomipramine, tranilcypramine, levodopa, and MAOI inhibitors.

Question 82

What does the tyramine effect do?

Answer 82

Triggers nerve cells to release noradrenaline, increasing blood pressure and causing throbbing headaches.

Question 83

List some foods that contain tyramine.

Answer 83

* Mature cheese * Pickled herring * Broad bean pods * Bovril * Oxo * Marmite * Fermented soya and bean extract

Question 84

What should patients be advised to do regarding food while on MAOIs?

Answer 84

Eat only fresh food and avoid stale food.

Question 85

What should patients avoid while taking MAOIs?

Answer 85

Alcoholic drinks.

Question 86

How long does the danger of drug and food interaction last after stopping MAOIs?

Answer 86

Two weeks.

Question 87

What effect can MAOIs have on skilled tasks?

Answer 87

Drowsiness may affect skilled tasks.

Question 88

What is Meclobemide and its advantages?

Answer 88

A reversible MAOI with less tyramine effects and lower risk of drug interactions.

Question 89

Should other antidepressants be started immediately after stopping MAOIs?

Answer 89

No, they should not be started for two weeks after stopping MAOIs.

Question 90

How long should patients wait after stopping a tricyclic or related antidepressant before starting a new medication?

Answer 90

At least 7 to 14 days.

Question 91

What is the waiting period after stopping an SSRI?

Answer 91

At least one week.

Question 92

What is the waiting period after stopping Fluoxetine?

Answer 92

At least five weeks.