Major Depressive Disorder

Question 1

What three antidepressants are strong CYP2D6 inhibitors?

Answer 1

fluoxetine, paroxetine, and bupropion (fluoxetine also inhibits CYP3A4)

Question 2

Which SSRIs/SNRIs have cardiovascular related side effects?

Answer 2

citalopram, escitalopram, and venlafaxine

Question 3

Which antidepressants are known for inducing weight gain?

Answer 3

paroxetine and mirtazapine (in addition to many TCAs)

Question 4

Which antidepressants are known to cause weight loss?

Answer 4

duloxetine and bupropion

Question 5

What are the 5 contraindications for bupropion?

Answer 5

• abrupt discontinuation of alcohol, benzodiazepines, or antiepileptics
• bulimia and anorexia nervosa
• seizure disorder
• Use of MAOI within 14 days
• Use with another bupropion product

Question 6

What are the two “sex friendly” antidepressants?

Answer 6

bupropion and vilazodone

Question 7

Which two antidepressants have the highest risk of discontinuation syndrome?

Answer 7

paroxetine and vortioxetine

Question 8

What’s the black box warning for all antidepressants?

Answer 8

Increased risk of suicide in children, adolescents, and young adults

Question 9

What antidepressant is FDA approved for postpartum depression?

Answer 9

brexanolone

Question 10

What is the serious/rare side effect associated with mirtazapine?

Answer 10

agranulocytosis (0.1% risk)

Question 11

What is the serious/rare side effects associated with trazodone?

Answer 11

priapism

Question 12

What is the mnemonic device used to remember the subjective symptoms of depression?

Answer 12

DIGS-CAPES
D- Depressed mood
I- Loss of interest 
G-  Guilt
S- Sleep disturbance
C- Loss of Concentration
A- Appetite changes
P- Psychomotor agitation/retardation
E- Loss of energy
S- Suicidal ideations

Question 13

If a patient has 2 prior episodes of depression, what is the likelihood that they will have a recurrent depressive episode?

Answer 13

70%

Question 14

Which antidepressant can be stopped cold-turkey due to it’s long half-life?

Answer 14

fluoxetine (stopping this antidepressant abruptly will not cause discontinuation syndrome since it’s long half-life (4-6 days) will allow for self-tapering)
DLC memory tool 4-6 days is how long a flu typically lasts in our system

Question 15

Which antidepressant is known for causing diarrhea?

Answer 15

Sertraline

DLC memory tool Remember squirt-raline!

Question 16

What patient population should we avoid duloxetine in?

Answer 16

Hepatitis C and severe alcoholism
DLC memory tool Both hepatitis C and severe alcoholism affects the liver. The liver has a DUAL blood supply (portal vein and hepatic artery)! DUAL= DULoxetine

Question 17

Which of the SSRI antidepressants has more anticholinergic side effects?

Answer 17

Paroxetine
Paroxetine has a lot of anticholinergic side effects, in addition to weight gain, and sexual dysfunction
DLC memory tool You will be PARCHED while on PARoxetine

Question 18

What types of foods should be avoided with MAOIs and why?

Answer 18

Tyramine containing foods (wine, aged cheese, avocado, chocolate, beer).
If taken with MAOIs, this can lead to life threatening reactions!

Question 19

What is the first line treatment option (non-medication) for major depressive disorder with a seasonal pattern (i.e. seasonal affective disorder)?

Answer 19

Bright light therapy