Depression Therapeutics

Question 1

true or false

not all antidepressants are equally effective

Answer 1

false - they are

Question 2

should antidepressants be taken at the same time daily

Answer 2

yes

Question 3

antidepressants must be taken for at least…..

Answer 3

6-9 months

Question 4

are antidepressants addictive

Answer 4

no

Question 5

the criteria for diagnosing depression:

depressed mood and/or loss of interest or pleasure in life activities for at LEAST:

Answer 5

2 weeks

and also at least 5 of a laundry list of symptoms that cause clinically significant impairment in social, work, or other areas

Question 6

average age of onset of depression

Answer 6

late 20s

Question 7

what does the PHQ-2 assessment ask

Answer 7

over the past 2 weeks, how often have you been bothered with:

-little interest or pleasure in doing things

-feeling down, depressed, or hopeless

Question 8

depression treatment goals

Answer 8

full return to function with a min of 3 weeks of no depressed mood or anhedonia (not finding pleasure in things you used to)

no more than 3 remaining symptoms of major depressive disorder

Question 9

3 nonpharm therapy for depression

Answer 9

-psychotherapy

-electroconvulsive therapy (ECT)

-light therapy

Question 10

psychotherapy includes cognitive behavioral therapy

however, when is psychotherapy MOST EFFECTIVE

Answer 10

in combo with drug treatment

Question 11

in what patients is electroconvulsive therapy used?

Answer 11

patients who need a rapid response, can’t tolerate meds, or who had a good response to it in the past

Question 12

light therapy is used for….
what do you need to get beforehand?

Answer 12

seasonal affective disorder

baseline eye exams

Question 13

true or false

for psychotic depression, electroconvulsive therapy is more effective than medications alone

Answer 13

TRUE

Question 14

who can electroconvulsive therapy NOT be used in

Answer 14

no absolute CI’s - can be used in older pts, even with pacemakers and defibrillators

however, ECT does have DDIs with lithium, theophylline, anticonvulsants, and antidepressants - so need to d/c

Question 15

true or false

electroconvulsive therapy cannot be used in pregnancy

Answer 15

false - it can

Question 16

what should be started after remission after a patient undergoes ECT

Answer 16

antidepressants + mood stabilizer

Question 17

place in therapy for ECT

Answer 17

like 4th or 5th line

used for relapse prevention

Question 18

top 4 EFFICACY antidepressants

Answer 18

mirtazapine
lexapro
venlafaxine
sertraline

Question 19

top 4 ACCEPTABILITY antidepressants

Answer 19

lexapro
sertraline
buproprion
citalopram

Question 20

paroxetine class

Answer 20

SSRI

Question 21

name 4 SNRIs

Answer 21

venlafaxne
desvenlafaxine
duloxetine
levomilnacipran

Question 22

name an NDRI (norepinephrine and dopamine reuptake inhibitor)

Answer 22

buproprion

Question 23

imipramine and desipramine class

Answer 23

Tricyclics

Question 24

doxepin class

Answer 24

tricyclic

Question 25

amitriptyline and nortriptyline class

Answer 25

tricyclic

Question 26

phenelzine class

Answer 26

MAO inhibitor

Question 27

tranylcypromine class

Answer 27

MAO inhibitor

Question 28

selegiline class

Answer 28

MAO inhibitor

Question 29

*boxed warning for ALL antidepressants and what this means for healthcare providers

Answer 29

increased risk of suicide in children, adolescents, and young adults (up to 24) provider responsibility to alert patient and caregiver! encourage strict monitoring of symptoms

Question 30

what is the suicide hotline

Answer 30

988

Question 31

when is the greatest risk of the boxed warnings of all antidepressants (increased risk suicide)

Answer 31

during initiation and during dose titration/taper

Question 32

signs and symptoms of serotonin syndrome

Answer 32

anxiety, shivering, sweating, tremor, autonomic instability

Question 33

how long does ACUTE treatment last for MDD? continuation? maintenance?

Answer 33

acute - 3 months continuation - 4-9 months maintenance duration is variable - depends on the number and severity of episodes, etc

Question 34

3 criteria in which a patient would get INDEFINITE maintenance drug treatment for MDD

Answer 34

-3 or more previous episodes -2 or more previous episodes and over 50 - 1 or more previous episodes and over 60

Question 35

symptoms of withdrawal from antidepressants and how to avoid them

Answer 35

flu-like symptoms - dizziness, nausea, paresthesia, anxiety, insomnia. can last 3-7 days. onset happens 36-72 hrs after stopping to avoid - need to taper dose! may need to be a very long and gradual taper

Question 36

which particular antidepressants have worse withdrawal symptoms and why

Answer 36

paroxetine and venlafaxine have a short half life

Question 37

true or false tricyclics are not first line for MDD

Answer 37

TRUE large OD potential, lot of DDI, lot of SE highly protein bound, metabolized by CYP2D6

Question 38

tricyclics are occassionally used for ______ in low doses

Answer 38

neuropathic pain

Question 39

name some side effects of tricyclic antidepressants

Answer 39

anticholinergic orthostatic hypotension weight gain sedation sexual dysfunction arrhythmias

Question 40

tricyclic dosing?/

Answer 40

??

Question 41

which class is the drug of choice in atypical depression

Answer 41

MAO inhibitors

Question 42

what foods shouldn't be taken with MAO inhibitors

Answer 42

high amounts of tyramine!!! pickled meat or fish sauerkraut aged cheeses yeast extracts fava beans moderate - beer, avacados, meat extracts, red wines

Question 43

name some things that have LOW amounts of tyramine and thus are okay to take with MAO inhibitors

Answer 43

caffeine beverages (2oz) distilled spirits (3oz) chocolate soy sauce cottage and cream cheese (2oz) yogurt and sour cream (2oz)

Question 44

why are tyramine containing foods and MAO inhibitors together dangerous

Answer 44

fatal hypertensive crisis

Question 45

2 drugs that, with MAO I's, can cause fatal hypertensive crisis

Answer 45

sympathomimetics meperidine

Question 46

MAO I dosing??

Answer 46

??

Question 47

true or false SSRIs are equally effective as TCA

Answer 47

true - but better tolerated

Question 48

which class of antidepressants can also help in generalized anxiety disorder, panic disorder, and OCD?

Answer 48

SSRIs

Question 49

true or false SSRIs are generally less sedating

Answer 49

true

Question 50

true or false SSRIs are less likely to exacerbate comorbid conditions

Answer 50

true

Question 51

why are SSRIs commonly used 1st line even tho they are equally effective to TCA

Answer 51

better SE profile QD dosing safety in OD also less likely to exacerbate comorbid conditions

Question 52

rank according to their CYP enzyme inhibition: citalopram, fluoxetine, fluvoxxamine, paroxetine, sertraline

Answer 52

most - fluvoxamine fluoxetine paroxetine least - citalopram and sertraline

Question 53

true or false a concern of the SSRIs is that they induce some CYPS

Answer 53

false - inhibit

Question 54

SSRIs + warfarin

Answer 54

increased risk of bleed

Question 55

linezolid/tramadol/tapentadol + SSRI

Answer 55

risk of serotonin syndrome

Question 56

st john's wort + SSRI

Answer 56

possible serotonin syndrome, increased hypnotic effects

Question 57

MAOI + SSRI

Answer 57

can be fatal due to excess serotonin

Question 58

FDA public health advisory

Answer 58

warned providers about serotonin syndrome from SSRI. SNRI, triptans prescribers should weigh risk/benefit and discuss serotonin syndrome with patients. follow them closely esp when just initiating treatment

Question 59

some SE of SSRI

Answer 59

nervous, agitation insomnia, somnolence transient NV weight loss/gain tremor hyponatremia/SIADH sexual dysfunction

Question 60

what is the most activating SSRI and thus SHOULD NOT be used in patient who have difficulty sleeping

Answer 60

fluoxetine

Question 61

which SSRI has the most anticholinergic effects and most likely to cause EPS

Answer 61

paroxetine

Question 62

which 3 SSRIs have a very high incidence of diarrhea

Answer 62

sertraline fluoxetine citalopram

Question 63

SSRI dosing???

Answer 63

??

Question 64

AE of SNRI that is different from SSRI

Answer 64

hypertension! due to increased NE

Question 65

true or false abrupt withdrawal of SNRIs should be avoided

Answer 65

true

Question 66

what is the active metabolite of venlafaxine that potentially has less side effects

Answer 66

desvenlafaxine

Question 67

name an SNRI that should be AVOIDED in CrCl less than 30 or in hepatic insufficiency

Answer 67

duloxetine

Question 68

another use for duloxetine

Answer 68

neuropathic pain

Question 69

DDI concern duloxetine

Answer 69

inhibits 2D6 - avoid MAO inhibitors