Major Depressive Disorder Flashcards
(31 cards)
What are the questions you should answer when switching antidepressants?
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?
A person must have either 1 of two qualities/symptoms to be diagnosed with depression. What are they?
Depressed mood OR loss of interest/pleasure (anedonia)
A person must have 4 of the following qualities/symptoms to be diagnosed with depression. What are they?
weight/appetite changes
sleep disturbances
psychomotor = agitation/retardation
fatigue
worthlessness
executive dysfunction
suicidal ideation
How would you describe the mild depression subtype?
distressed by sx
difficulty carrying out usual activities
How would you describe the moderate depression subtype?
Severe sx to a degree
considerable difficulty continuing with usual activities
How would you describe the severe depression subtype?
Considerable distress or agitation or retardation
Unlikely to carry out usual activities beyond minimal extent
Suicide is particular risk, psychotic sx can occur
What are the first-line pharmacotherapies of major depressive disorder?
SSRIs = citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
Tetracyclic antidepressant = mirtazapine
What are the second-line pharmacotherapies of major depressive disorder?
SNRIs = desvenlafaxine, duloxetine, venlafaxine
other = agomelatine, vortioxetine
What are the third-line pharmacotherapies of major depressive disorder?
Reversible MAO = moclobemide
other = reboxetine
What SSRI has the longest half life? Why is this good/bad?
Fluoxetine t1/2 = 80 hours
Long waiting time when swapping over, has active metabolites
SS takes longer to reach
What SNRIs change BP?
(des)venlafaxine –> worsen BP
duloxetine = orthostatic hypotension (falls)
Which SNRIs are seen in more drug interactions?
Duloxetine = CYP1A2, CYP2D6
Which SNRIs are known to cause N/V?
Venlafaxine more than SSRIs
Duloxetine
Which TCAs have high rates of sedation, anticholinergic effects, and orthostatic hypotension?
Amitriptyline
doxepin
Which MAOIs are “reversible and selective” and which are “irreversible and non-selective”?
R & S = moclobemide
I & NS = phenelzine & tranylcypromine
What are some considerations with Mirtazapine?
sedation
weight gain
What are some considerations with agomelatine?
? benefit in MD
Hepatic disorders
Less sexual dysfunction than SSRI/SNRI
Which antidepressants are prone to CYP interactions?
Fluvoxamine (heaps)
Fluoxetine (heaps)
Duloxetine (one)
Paroxetine (one)
What is the reaction between tyramine and MAOI?
MAOI inhibit tyramine breakdown –> tyramine displaces noreadrenaline from storage vesicles –> inc noreadrenaline and BP
What are the sx of tyramine-MAOI interactions?
Occipital headache
pounding heart
Neck stiffness
Sweating
N/V
Why happens in serotonin syndrome and what are the sx?
MOA = hyperstimulation of serotonin receptors
Sx:
- hyperreflexia, clonus, tremor, incoordination
- mental state changes: confusion, hypomania, agitation
- Shivering, sweating, fever, diarrhoe
What antidepressants reduce the seizure threshold in epilepsy?
SSRIs, SNRIs
Mainserin, mirtazpine, reboxetine
Irreversible MAOi
What antidepressants can trigger a manic episode in bipolar disorder?
All antidepressants (esp SSRI, SNRI)
What antidepressants can worsen/result/should you careful of in cardiovascular disorders?
TCAs, irreversible MAOIs
SNRIs, (es)citalopram, mainserin
