Depression Flashcards
(44 cards)
What is the lifetime prevalence of depression?
16%
How many depressed patients seek treatment?
1/3
Anxiety and Substance abuse are what to depression?
Comorbidities
Who is more likely to be depressed? gender?
>= 65 years old.
Women are more likely than men
What are the risk factors of depression?
Who is most likely to complete suicide?
- Gender- Female
- 18-29 and >65
- Family history
- Prior episodes of depression or suicide attempt
- Comorbid psychiatric illness
- Social Stressor
How is the onset of depression presented?
The symptoms gradually develop over days
Risk of Reoccurrence
- 1 episode:
- 2 episodes
- 3 episodes
Pts with recurrent depression are at an increase risk for what?
50-60%
70%
90%
Bipolar
What is the monoamine hypothesis?
These hypotheses dont explain what?
Lack of DA, 5-HT, and NE
The lag time for antidepressants to take effect
What are the target signs and symptoms of depression?
At least one of these needs to be?
- Depression
- Sleep (insomnia, hypersomnia)
- Loss of interest
- Guilt
- Energy loss
- Loss of concentration
- Loss or gain appetite
- Psychomotor (agitation or retardation)
- Suicide
One either Depression or loss of interest
Differential Diagnosis of Major Depressive disorder?
- Bipolar affective disorder (manic symptoms)
- Substance-induced mood disorder
- Mood disorder caused by general medical condition
- Dementia
- Dysthymia- Greater than two years of depressed mood
- Adjustment disorder with depressed mood
What are the common medical conditions that are associated with depression?
- Hypothyroidism
- Heart disease CHF, MI
- Post stroke
- Parkinsons
- Alzheimers
- AIDS
- Anemia
- Anxiety disorder
- Schizophrenia
- Alcholism
- Eating disorder
Monamine Oxidase Inhitors
- Phenelzine (Nardil)
- Tanylcyprmine (Parnate)
- Selegiline (EmSam)- Patch
Tertiary Amine TCAs name them
What do they cause more of?
- Amitriptyline
- Doxepin
- Imipramine
Cause more SEs all TCAs are primarily used off label for sleep and pain disorders in adults
Secondary Amine TCAs
- Protriptyline
- Nortriptyline
- Despiramine
What are the key points when providing TCAs?
Whats dangerous
SEs
Who to avoid in?
- They are Dangerous in overdose
- Cardiac and Anticholinergic SEs- Dry mouth, constipation,
- Avoid in elderly
What are the SSRIs?
- Citalopram (celexa)
- Escitalopram (Lexapro)
- Fluaxetine (Prozac, Prozac weekly, Sarafem)
- Fluvoxmine (Luvox, ER)- only for OCD
- Paroxetine (Paxil and CR) - Mild anticholinergic, Avoid in elderly
- Sertraline (Zoloft)
SNRIs used in Depression
- Venlafaxine (Effector, XR)
- Desvenlafaxine (Pristiq)
- Duloxetine (DM neuropathy) - Cymbalta
- Levomilnacipran (Fetzima)
SEs for SNRIs and SSRIs
What is the Key take away with the Side Effects
- S- Stomach (N/V/D)- Due to receptors in gut
- S- Sexual Dysfunction
- R-Restlessness
- I-Insomnia
- Headache
- Weight gain can be a good thing
- Withdrawal from abrupt discontinuation
Most of these SEs stop after 1-2 weeks
Except for sexual dysfunction and Weight Gain
Citalopram Special SEs?
What doses to avoid?
What about old people?
- QTc prolongation
- avoid dose > 40 mg
- Patients > 60 should avoid dose > 20
SNRIs have been know to increase?
Diastolic BP
Duloxetine has a?
Should be avoided in?
- LFT warning
- Avoid use in patients with pre-existing liver insufficiency and alcoholics
Withdrawal reactions with SNRIs and SSRIs
- Agents with short half lifes- SNRIs but also some SSRIs
- Dizziness, Insomnia, fatigue, anxiety, agitation, nausea, vomit, sweating, tingling, sensory disturbances (Brainzaps)
- Taper dose when disconituing
Mertazapine (Rameron)
Interacts with?
AEs due to histamine blockade?
Clonadine interaction
AE- Somnolence, weight gain, Constipation, Lower risk of sexual dysfunction than SSRIs
Bupropion (Wellbutrin)
AEs?
Contraindication?
Could worsen and known to cause? Should be taken when?
- Insomnia, Tremor, Nervousness, dry mouth
- Contra in seizures and eating disorders
- Can worsen anxietym known to cause insomnia so take in the morning
