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PT III > Major Depressive Disorder > Flashcards

Major Depressive Disorder Flashcards

1
Q

What are the questions you should answer when switching antidepressants?

A

How do you get off drug A?

Do you need a break between A and B?

When/how will you start drug B?

When do we inc/dec/check the dose of drug B?

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2
Q

A person must have either 1 of two qualities/symptoms to be diagnosed with depression. What are they?

A

Depressed mood OR loss of interest/pleasure (anedonia)

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3
Q

A person must have 4 of the following qualities/symptoms to be diagnosed with depression. What are they?

A

weight/appetite changes

sleep disturbances

psychomotor = agitation/retardation

fatigue

worthlessness

executive dysfunction

suicidal ideation

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4
Q

How would you describe the mild depression subtype?

A

distressed by sx

difficulty carrying out usual activities

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5
Q

How would you describe the moderate depression subtype?

A

Severe sx to a degree

considerable difficulty continuing with usual activities

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6
Q

How would you describe the severe depression subtype?

A

Considerable distress or agitation or retardation

Unlikely to carry out usual activities beyond minimal extent

Suicide is particular risk, psychotic sx can occur

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7
Q

What are the first-line pharmacotherapies of major depressive disorder?

A

SSRIs = citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

Tetracyclic antidepressant = mirtazapine

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8
Q

What are the second-line pharmacotherapies of major depressive disorder?

A

SNRIs = desvenlafaxine, duloxetine, venlafaxine

other = agomelatine, vortioxetine

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9
Q

What are the third-line pharmacotherapies of major depressive disorder?

A

Reversible MAO = moclobemide

other = reboxetine

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10
Q

What SSRI has the longest half life? Why is this good/bad?

A

Fluoxetine t1/2 = 80 hours

Long waiting time when swapping over, has active metabolites

SS takes longer to reach

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11
Q

What SNRIs change BP?

A

(des)venlafaxine –> worsen BP

duloxetine = orthostatic hypotension (falls)

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12
Q

Which SNRIs are seen in more drug interactions?

A

Duloxetine = CYP1A2, CYP2D6

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13
Q

Which SNRIs are known to cause N/V?

A

Venlafaxine more than SSRIs

Duloxetine

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14
Q

Which TCAs have high rates of sedation, anticholinergic effects, and orthostatic hypotension?

A

Amitriptyline

doxepin

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15
Q

Which MAOIs are “reversible and selective” and which are “irreversible and non-selective”?

A

R & S = moclobemide
I & NS = phenelzine & tranylcypromine

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16
Q

What are some considerations with Mirtazapine?

A

sedation
weight gain

17
Q

What are some considerations with agomelatine?

A

? benefit in MD

Hepatic disorders

Less sexual dysfunction than SSRI/SNRI

18
Q

Which antidepressants are prone to CYP interactions?

A

Fluvoxamine (heaps)
Fluoxetine (heaps)

Duloxetine (one)
Paroxetine (one)

19
Q

What is the reaction between tyramine and MAOI?

A

MAOI inhibit tyramine breakdown –> tyramine displaces noreadrenaline from storage vesicles –> inc noreadrenaline and BP

20
Q

What are the sx of tyramine-MAOI interactions?

A

Occipital headache
pounding heart
Neck stiffness
Sweating
N/V

21
Q

Why happens in serotonin syndrome and what are the sx?

A

MOA = hyperstimulation of serotonin receptors

Sx:
- hyperreflexia, clonus, tremor, incoordination
- mental state changes: confusion, hypomania, agitation
- Shivering, sweating, fever, diarrhoe

22
Q

What antidepressants reduce the seizure threshold in epilepsy?

A

SSRIs, SNRIs

Mainserin, mirtazpine, reboxetine

Irreversible MAOi

23
Q

What antidepressants can trigger a manic episode in bipolar disorder?

A

All antidepressants (esp SSRI, SNRI)

24
Q

What antidepressants can worsen/result/should you careful of in cardiovascular disorders?

A

TCAs, irreversible MAOIs

SNRIs, (es)citalopram, mainserin

25
Q

Which antidepressants can cause orthostasis and falls in elderly?

A

TCAs

MAOI

26
Q

Which antidepressants are preferred in preg?

A

SSRIs (NOT PAROXETINE) > TCA > SNRI & mirtazapine

27
Q

What effects are seen in the first week of antidepressant therapy?

A

Improvement in sleep, appetite disturbance, executive functioning improve

28
Q

What effects are seen in the first three weeks of antidepressant therapy?

A

Improved energy, memory, self-care

29
Q

What effects are seen in the first four weeks of antidepressant therapy?

A

depressed mood and suicidality don’t improve for at least 4 weeks or longer

30
Q

How long are antidepressants continued for once a response is seen?

A

continue for at least 6 months

Preferably 12 months

Min 3 weeks

85% risk of relapse

31
Q

What drugs are used in augmentation strategies in depression?

A

Lithium

Liothyronine

Second generation antipsychotics
- quetiapine & aripiprazole - more evidence
- Risperidone & olanzapine - some evidence

PT III (6 decks)

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