Depression and Antidepressants

Question 1

Prozac

Answer 1

Fluoxetine (long half life, CYP450, jitters) am dosing

Question 2

Zoloft

Answer 2

Sertraline (MINIMAL drug interactions, jitters) am doising

Question 3

Paxil

Answer 3

Paroxetine (anti-cholinergic (dry mouth) and weight gain and sexual dysfunction, sedation)

Question 4

Luvox

Answer 4

Fluvoxamine

Question 5

Celexa

Answer 5

Citalopram (cardiac concern >40mg)

Question 6

Lexapro

Answer 6

Escitalopram (less problematic than Citalopram)

Question 7

Brintellix

Answer 7

Vortioxetine

Question 8

Viibryd

Answer 8

Vilazodone

Question 9

Clomipramine (causes seizures)

Answer 9

Anafranil (TCA and SSRI overlap)

Question 10

TCA’s

Answer 10

Amitriptyline, Imipramine, Doxepin, Desipramine, Nortriptyline (More potent)

Question 11

Effexor

Answer 11

Venlafaxine (GI and Sexual Dys. Adverse effects)

Question 12

Pristiq

Answer 12

Desvenlafaxine (active metabolite of Effexor, significant renal elimination)

Question 13

Cymbalta

Answer 13

Duloxetine (indicated for depression, neuropathy, pain) hepatotoxic with EtOH

Question 14

Fetzima

Answer 14

Levomilnacipran

Question 15

Trazodone

Answer 15

Oleptro (SR form)

Question 16

Wellbutrin

Answer 16

Bupropion (Works on DA, use in substance abuse, minimal action at receptor, RISK of SEIZURE/tremor, MAY treat sexual dysfunction)

Question 17

Remeron

Answer 17

Mirtazapine (decreased GI and sex. dys. effects and less sleep disturbance) increased drowsiness and appetite

Question 18

Nardil

Answer 18

Phenelzine (MAOI)

Question 19

Parnate

Answer 19

Tranylcypromine (MAOI)

Question 20

Marplan

Answer 20

Isocarboxazide (MAOI)

Question 21

EmSam

Answer 21

Selegeline Patch (MAOI)

Question 22

Unipolar Depressive Disorder

Answer 22

mood disorder, No mania or hypomania, Isolated episodes, chronic or recurring, debilitating, Social/Family and Employment impairments, SUICIDE RISK

Question 23

Bi-Polar Disorder

Answer 23

mood disorder, 1 or more episodes of mania or hypomania AND depressed (many times first), recurrent

Question 24

Mania

Answer 24

greater than 1 wk, elevated or expansive mood and IMPAIRMENT OF FUNCTION, grandiosity, excessive pleasure (like your on meth)

Question 25

Hypomania

Answer 25

less severe than mania, NOT psychotic, opposite of mania

Question 26

Depressive Disorder

Answer 26

Genetic Component and environmental role, Stress may precipitate those at risk, Women > Men, Onset is early to middle adulthood

Question 27

Diagnostic Criteria of Major Depressive Disorder

Answer 27

>5 for a two week period, significant change in functioning, Either Depressed Mood or Loss of interest, then: change in weight, insomnia/hypersomnia, fatigue, indecisiveness, inappropriate guilt, psychomotor retardation, suicidal thoughts (not caused by underlying medical of pharmaceutical agent) SIG-E-CAPS

Question 28

Drug Induced Depression

Answer 28

Clonidine, Ethanol, Steroids, Estrogens, Interferons, Amnesteem

Question 29

Illness Induced Depression

Answer 29

Alzheimer's, MS, Epilepsy, Parkinson's, Addison's, Hypothyroidism

Question 30

Depression Treatment

Answer 30

Pharmacotherapy, Psychotherapy (talk therapy), ECT (Electroconvulsiv Therapy), VNS, Trans-cranial Magnetic Stimulation, Light Therapy, Sleep Deprivation, Nutraceuticals

Question 31

Tricyclic Antidepressants

Answer 31

Not First Line, Prominently NE some 5HT reuptake inhibition

Question 32

TCA Adverse Effects

Answer 32

A1 Antagonists, M1 Antagonists, H1 Antagonists (increased appetite and weight gain), Cardiac Block, OVERDOSE TOXICITY

Question 33

TCA Dosing

Answer 33

Titrate Up, Dosing at bedtime, Drug Interactions (Dirty)

Question 34

SSRI Side Effects

Answer 34

Nausea/Anorexia, Insomnia, Sexual Dysfunction, Anxiety and Restlessness, Unwanted stimulation of 5HT-2 and 5HT3 receptors, Platelet Dysfunction, Water retention

Question 35

SSRI MOA

Answer 35

Prominent 5HT re-uptake blockade, NE too (but much less), Weight Neutral

Question 36

5HT-2 Stimulation

Answer 36

Nightmares, sleep disturbance, agitation, sexual dysfunct.

Question 37

5HT-3 Stimulation

Answer 37

GI Effects- N,V,D

Question 38

SNRI MOA

Answer 38

Serotonin/NE reuptake Inhibitor, work like TCA's without TCA side effects

Question 39

Trazodone MOA

Answer 39

5HT reuptake inhibitor and 5HT2 antagonist, used as a hypnotic, can cause priapism

Question 40

Remeron MOA

Answer 40

A2-antagonist (increased 5HT and NE release) and 5HT2 and 5HT3 antagonis

Question 41

MAOI MOA

Answer 41

Release of NE and 5HT, 3-4th line, IRREVERSIBLE, tyramine diet restrictions, lots of drug-drug interactions

Question 42

Serotonin Syndrome

Answer 42

Myoclonus (involuntary jerking of muscle), Hyperreflexia, confusion, hypomania, potential Hyperthermia, seizures, dyspnea, chattering of the teeth.

Question 43

Serotonin Syndrome Frequency

Answer 43

Uncommon, seen with Triptans, Trazodone and others

Question 44

Serotonin Synd. Treatment

Answer 44

With drawl of serotonin agents, IV ativan, propranolol (5TH antagonist), cyproheptadine (5HT2 antagonist)

Question 45

Antidepressant withdrawal symptoms

Answer 45

opposite of serotonin syndrome, Flu-like symptoms (aches and pains), brain shocks and zaps, nausea

Question 46

Antidepressant Patient Education

Answer 46

Delayed onset of action, duration of therapy, withdrawal sx., use with alcohol, adverse effects