Last Lap Preparation > Depression > Flashcards

Depression Flashcards

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1
Q

What are the depressive disorders included in the DSM-5-TR?

A
  • Major depressive disorder (MDD)
  • Persistent depressive disorder
  • Disruptive mood dysregulation disorder
  • Premenstrual dysphoric disorder
  • Substance-induced mood disorder
  • Mood disorder due to a general medical condition
  • Other specified depressive disorder
  • Unspecified depressive disorder

This chapter primarily focuses on major depressive disorder and persistent depressive disorder.

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2
Q

What is the lifetime prevalence of MDD in Canada?

A

Approximately 10%

The annual prevalence of a major depressive episode is just under 5%.

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3
Q

What are the goals of therapy for depressive disorders?

A
  • Achieve remission of depressive symptoms
  • Treat concomitant symptoms/disorders
  • Prevent suicide
  • Restore optimal functioning
  • Prevent recurrence

These goals guide the treatment approach for individuals with depression.

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4
Q

What is the Patient Health Questionnaire (PHQ-9) used for?

A

A patient-rated assessment tool for major depressive episodes

It consists of 9 questions that correspond to the DSM-5 criteria.

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5
Q

What are the diagnostic criteria for a major depressive episode?

A
  • Depressed mood or loss of interest/pleasure
  • Five or more symptoms present for 2 weeks
  • Clinically significant distress or impairment
  • Not attributable to substance effects or another medical condition
  • No history of manic or hypomanic episodes

These criteria help in diagnosing major depressive disorder.

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6
Q

True or false: Persistent depressive disorder is characterized by more severe symptoms than major depressive disorder.

A

FALSE

Symptoms of persistent depressive disorder are typically fewer and less severe than those of MDD.

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7
Q

What are the first-line psychotherapies for treating depression?

A
  • Cognitive behavioural therapy (CBT)
  • Behavioural activation (BA)
  • Interpersonal therapy (IPT)

These therapies are effective for mild to moderate depression.

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8
Q

What is the Edinburgh Postnatal Depression Scale (EPDS) used for?

A

Screening for depressive symptoms during pregnancy and postpartum

It is the most widely used and well-validated tool for this purpose.

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9
Q

What are the nonpharmacologic choices for treating depression?

A
  • Psychotherapy
  • Regular physical exercise
  • Yoga
  • Light therapy
  • Motivational interviewing
  • Psychoeducation

These options can be effective alone or as adjuncts to pharmacotherapy.

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10
Q

What is the recommended duration for light therapy exposure?

A

30 minutes per day

Improvement in depressive symptoms usually occurs within 1–3 weeks.

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11
Q

What are the first-line antidepressants according to the 2016 CANMAT guidelines?

A
  • Agomelatine
  • Amitriptyline
  • Escitalopram
  • Mirtazapine
  • Paroxetine
  • Venlafaxine
  • Vortioxetine

These medications are recommended based on their efficacy and tolerability.

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12
Q

What is the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16)?

A

A widely used alternative to the PHQ-9

It consists of 16 multiple choice questions covering DSM-5 criteria.

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13
Q

What are the monitoring parameters for depression?

A
  • Baseline assessments
  • Ongoing assessment
  • Special populations considerations

These parameters help in tracking the progress and effectiveness of treatment.

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14
Q

What is the role of psychoeducation in treating depression?

A

Enhances adherence to antidepressant therapy

Effective messages include taking medication daily and understanding the time it may take to see effects.

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15
Q

What is the Hamilton Depression Rating Scale (HAMD-7) used for?

A

Rating severity and remission of depression

It is a validated, brief assessment designed for healthcare professionals.

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16
Q

Name three antidepressants that appear to be among the most effective and well-tolerated options.

A
  • Agomelatine
  • Escitalopram
  • Vortioxetine

Agomelatine is not available in Canada.

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17
Q

True or false: Exposure to SSRIs reduced the risk of suicide by more than 40% in mid- and late-life adults with moderate to severe depression.

A

TRUE

This finding is based on a systematic review of observational studies involving more than 200,000 adults.

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18
Q

What are the first-line agents for treating depression according to CANMAT classification?

A
  • Bupropion
  • Citalopram
  • Desvenlafaxine
  • Duloxetine
  • Escitalopram
  • Fluoxetine
  • Fluvoxamine
  • Mirtazapine
  • Paroxetine
  • Sertraline
  • Venlafaxine
  • Vortioxetine

These agents are listed in alphabetical order rather than in order of preference.

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19
Q

What is the time to onset for SSRIs?

A

2–4 weeks

The rate of response for SSRIs is 60–70%, comparable to tricyclic antidepressants.

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20
Q

List the common side effects of SSRIs.

A
  • GI tract effects
  • CNS effects
  • Sexual dysfunction

SSRIs can increase the risk of GI bleeding, particularly in patients with additional risk factors.

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21
Q

Fill in the blank: Venlafaxine has inhibitory effects on serotonin reuptake at any therapeutic dose and also inhibits norepinephrine reuptake at doses of _______ mg daily.

A

> 150

Rates of remission with venlafaxine have been reported to be 6–10% higher compared to SSRIs.

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22
Q

What are the common adverse effects of Desvenlafaxine?

A
  • Insomnia
  • Somnolence
  • Dizziness
  • Nausea

Desvenlafaxine is the active metabolite of venlafaxine.

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23
Q

True or false: Duloxetine is indicated for both depression and neuropathic pain.

A

TRUE

It is also indicated for pain associated with fibromyalgia.

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24
Q

What is the mechanism of action for Bupropion?

A

Norepinephrine and dopamine reuptake inhibition

Bupropion is a first-line agent for MDD and is also indicated for smoking cessation.

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25
List the **common adverse effects** of Mirtazapine.
* Sedation * Weight gain ## Footnote Mirtazapine has a lower rate of GI and sexual side effects.
26
What is the primary concern with prescribing **Monoamine Oxidase Inhibitors (MAOIs)**?
Potentially fatal food and drug interactions ## Footnote These include hypertensive crisis and serotonin syndrome.
27
Fill in the blank: **Trazodone** is often prescribed at lower doses (50–100 mg) as a _______ in combination with other antidepressants.
hypnotic ## Footnote Trazodone is rarely prescribed at therapeutic antidepressant doses due to severe daytime sedation.
28
What is the **risk** associated with rapid discontinuation of most antidepressants?
Discontinuation syndrome ## Footnote Symptoms may include anxiety, crying, headache, and insomnia.
29
What should be done if a patient experiences severe **adverse effects** from antidepressant therapy?
* Lower the dose * Switch agent ## Footnote Consider these options if adverse effects persist for longer than 2 weeks or are intolerable.
30
What is the **incidence** of nausea with fluvoxamine?
37% ## Footnote Nausea is a common side effect of several antidepressants.
31
True or false: **Sexual dysfunction** usually improves in patients who achieve remission of depression.
TRUE ## Footnote Consider starting a PDE5 inhibitor in male patients if needed.
32
What is the **recommended approach** for tapering antidepressant doses?
Gradually by approximately 25% per week ## Footnote Monitor for re-emergence of depressive symptoms during tapering.
33
What is **discontinuation syndrome** in relation to antidepressants?
A condition that may occur if patients abruptly stop or reduce their medication ## Footnote Symptoms can persist for several months and may include a re-emergence of depressive symptoms.
34
How should antidepressant doses be tapered to avoid **discontinuation syndrome**?
* Gradually by approximately 25% per week * Monitor for re-emergence of depressive symptoms ## Footnote Fluoxetine can be tapered more rapidly than other SSRIs due to its long half-life.
35
True or false: **Discontinuation syndrome** is a serious and life-threatening condition.
FALSE ## Footnote Severe symptoms usually resolve in 3 days or less.
36
What is a potential treatment if **discontinuation-emergent symptoms** do not resolve after several days?
* Restart the antidepressant * Taper the dose more slowly * Substitute with 1 dose of fluoxetine 10–20 mg PO ## Footnote A total of 3 doses spread over 7–10 days is considered acceptable.
37
What are **atypical antipsychotics** used for in the treatment of depression?
* Second-line option for depression * Adjuncts to antidepressants in adults with MDD ## Footnote Examples include aripiprazole and brexpiprazole.
38
What is the recommended observation period for response to **antipsychotics**?
Within 2 weeks of initiation ## Footnote This is crucial for assessing the effectiveness of the treatment.
39
Name a natural health product that has been evaluated for the treatment of **depression**.
* St. John’s wort * S-adenosylmethionine (SAM-e) * Omega-3 fatty acids ## Footnote Each has varying levels of evidence supporting their use.
40
What is the potential risk of using **St. John’s wort** with other serotonergic medications?
Increased risk of **serotonin syndrome** ## Footnote It can also decrease the bioavailability of many drugs.
41
What is **rapid-acting therapy** in the context of depression treatment?
Treatments that yield improvement in symptoms within days ## Footnote Examples include NMDA-modulators like ketamine and esketamine.
42
What is the recommended duration for **maintenance antidepressant therapies** after achieving remission?
A minimum period of 9 months ## Footnote This is especially important for patients with recurrent episodes.
43
Define **treatment-resistant depression (TRD)**.
Failure to respond after 2 or more treatments of adequate dose and duration ## Footnote The definition may vary based on the planned intervention.
44
What is the recommended approach when switching **antidepressants**?
* Switch out of class (e.g., SSRI to SNRI) * Consider switching within a class if there is a favourable clinical response ## Footnote Consult specialized resources for specific cross-tapering instructions.
45
What are the first-line pharmacologic options for **perinatal depression**?
* Citalopram * Escitalopram * Sertraline ## Footnote Fluoxetine is a second-line option due to its controversial association with major malformations.
46
What is the incidence of **postpartum blues** after pregnancy?
Affects up to 80% of patients ## Footnote Symptoms are self-limiting and require only monitoring and supportive care.
47
What is the recommended first treatment option for **postpartum depression**?
Psychotherapy, preferably IPT or CBT ## Footnote This is particularly important if the patient is breastfeeding.
48
What is the occurrence rate of **postpartum psychosis** in patients in Canada?
≤0.1% ## Footnote Postpartum psychosis is a rare but serious condition that can occur after childbirth.
49
True or false: The **blues** after pregnancy are considered a disorder.
FALSE ## Footnote The blues are common, self-limiting symptoms requiring only monitoring and supportive care.
50
What should be considered first for the treatment of **postpartum depression**?
Psychotherapy, preferably IPT or CBT ## Footnote This is particularly recommended if the patient is breastfeeding.
51
Name the **first-line pharmacologic options** for postpartum depression in breastfeeding patients according to the 2016 CANMAT guidelines.
* Sertraline * Escitalopram * Citalopram ## Footnote These medications are recommended due to their safety profile in breastfeeding.
52
What are the **second-line options** for postpartum depression treatment?
* Fluoxetine * Paroxetine * Nortriptyline ## Footnote Other antidepressants lack sufficient data for breastfeeding patients.
53
Which antidepressant is **not recommended** due to significant adverse effects in breastfed infants?
Doxepin ## Footnote It poses risks to the health of the breastfed infant.
54
What is **Brexanolone** approved for?
Management of postpartum depression ## Footnote It requires an extended infusion and is not available in Canada.
55
What should prescribers do to acquire expertise in the use of antidepressants?
Choose 1 or 2 agents from several antidepressant classes and use them consistently ## Footnote This helps in developing familiarity with the medications.
56
What should be considered when **individualizing therapy** for postpartum depression?
* Patient comorbidities * Significant symptoms of depression ## Footnote This includes symptoms like sleep disturbances and cognitive dysfunction.
57
What is the role of **combination therapy** in treating postpartum depression?
Superior to either modality alone ## Footnote It provides protection against early relapse compared to either treatment alone.
58
What is the importance of **maintenance therapy** in postpartum depression?
Reinforces treatment beyond the acute phase ## Footnote It helps in preventing relapse after initial treatment.
59
What is the recommended approach when **discontinuing antidepressants**?
Taper slowly over 4–6 weeks ## Footnote This is especially important for paroxetine and venlafaxine.
60
What should be reviewed in **nonresponders** to antidepressant treatment?
* Alcohol and drug abuse history * Medication adherence * Confirm diagnosis ## Footnote This helps in understanding treatment failures.
61
When should a patient be referred for **psychiatric consultation**?
* Psychotic symptoms * Acute suicidal ideation * After failure of 3 treatment trials ## Footnote These are critical situations requiring specialized care.
62
What is the correlation between **serum levels** of SSRI or SNRI antidepressants and clinical response?
Poor correlation ## Footnote This limits the role of therapeutic drug-level monitoring.
63
What is the limited benefit of **pharmacogenetic testing**?
Warranted in cases of treatment failure or intolerance ## Footnote It helps identify metabolizer status affecting treatment outcomes.
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