Major Depressive Disorders Flashcards
(127 cards)
1
Q
Are females or males more likely to have major depression?
A
Women
2
Q
Major depression rates are highest between these ages
A
19-29 years
3
Q
“SIG E CAPS” describes the criteria for major depressive disorder, and stands for this
A
Sleep disturbed
Interest or pleasure lost
Guilt increased
Energy depressed
Concentration depressed
Appetite disturbed
Pyschomotor activity disturbed
Suicidal ideation present
4
Q
What ages are more at risk for suicide?
A
Teenage or older than 45
5
Q
What gender has more risk for suicide?
A
Males
6
Q
“SAD PERSONS” describes the risk factors for suicide, and stands for this
A
Sex (male)
Age (<19 or >45)
Depression or hopelessness
Previous suicide attempt or psychiatric care
Excessive alcohol or drug use
Rational thinking loss
Separated, divorced, or widowed
Organized or serious attempt
No social supports
Stated future intent
7
Q
Subtype of depression with profound anhedonia and dysphoria
A
Major depression with Melancholia
8
Q
Subtype of depression with criteria met for >2 years
A
Chronic major depression
9
Q
Subtype of depression with typically milder depression, patients frequently cry
A
Dysthymia
10
Q
Subtype of depression with mood reactivity
Responses may appear normal for positive events
A
Atypical major depression
11
Q
Subtype of depression with favorable response to MAOIs
A
Atypical major depression
12
Q
Postpartum mood disturbances typically occur within this amount of time of delivery
A
1 month
13
Q
How long does maternal (postpartum) blues last?
A
Short duration ~2 weeks
14
Q
How long does postpartum depression last?
A
Up to one year
15
Q
How long does postpartum psychosis last?
A
Up to 2 months
16
Q
Postpartum mood disturbance that is short duration, and supportive therapy is common and adequate
A
Maternal (postpartum) blues
17
Q
Postpartum mood disturbance that lasts up to one year and requires antidepressant therapy
A
Postpartum depression
18
Q
Postpartum mood disturbance that has low incidence, lasts up to 2 months and requires antipsychotic/antidepressant therapy, possible hospitalization, and consideration of child safety
A
Postpartum psychosis
19
Q
Do symptoms of premenstrual dysphoric disorder improve or worsen after start of menses?
A
Improve
20
Q
What are the three phases of depression treatment?
A
Acute - remission of symptoms
Continuation - eliminate residual symptoms or prevent their emergence
Maintenance - prevent recurrent
21
Q
Phase of depression treatment that is remission of symptoms
A
Acute phase (~10 weeks)
22
Q
Phase of depression treatment that is to eliminate residual symptoms or prevent their emergence
A
Continuation phase (~9 months)
23
Q
Phase of depression treatment that prevents recurrence
A
Maintenance phase (~36 months)
24
Q
This may be the first line treatment for mild depression
A
Psychotherapy (if patient is willing)
25
This depression non-pharmacological therapy is ideal for patients needing rapid response or have failed to respond to pharmacotherapy
Electroconvulsive therapy (ECT)
(is repetitive transcranial magnetic stimulation)
26
Electroconvulsive therapy can be indicated for this condition, especially if psychotic features or catatonia are present
Major depressive disorder
(also bipolar, shizophrenia)
27
What are the three relative contraindications of Electroconvulsive therapy?
Cardiovascular disease
Cerebrovascular disease
High anesthetic risk
28
Is there absolute contraindications of electroconvulsive therapy?
None; only relative
29
Are antidepressants within a class of equivalent efficacy?
Yes
30
This is the long-lived active metabolite of fluoxetine
Norfluoxetine (half life of 8 days)
31
What is the half life of norfluoxetine, the active metabolite of fluoxetine?
8 days
32
Reducing the dose or concurrent use of benzodiazepines may help this adverse effect of SSRIs
Insomnia and anxiety
33
Insomnia and anxiety are adverse effects of SSRIs, and concurrent use of this drug may help
Benzodiazepines
34
This can occur in overdose of SSRIs, and can involve confusion, agitation, autonomic instability, hyperthermia, seizures, hyperreflexia, muscle rigidity, nystagmus, shivering, and seizures
Serotonin syndrome
35
Does serotonin syndrome involve hypothermia or hyperthermia?
Hyperthermia
36
Does serotonin syndrome involve bradycardia or tachycardia?
Tachycardia
37
Can seizures occur with serotonin syndrome?
Yes
(due to CNS stimulatory effects)
38
Withdrawal effects noted following abrupt discontinuation of this type of drug includes paresthesia/electric shock sensation and vivid dreams
SSRIs
39
Are there withdrawal effects from abrupt discontinuation of SSRIs?
Yes
(includes paresthesias/electric shock sensation and vivid dreams)
40
SSRIs have an increase risk of suicide or worsening depression, especially in this much time of therapy
First month
41
This is a shared risk with all antidepressants
Increased risk is not common among patients >24 years old
Risk may be lower among patients >65 years old
Suicide
42
This class of drugs is the first line antidepressants
SSRIs
43
This class of drugs is the second line treatments for depression
SNRIs (selective norepinephrine uptake inhibitors)
44
What type of drug is Fluoxetine?
SSRI
45
What type of drug is Paroxetine?
SSRI
46
What type of drug is Fluvoxamine?
SSRI
47
What type of drug is Venlafaxine?
SNRI
48
What type of drug is Duloxetine?
SNRI
49
Class of antidepressants with an adverse effect of dose dependent increase in BP
SNRIs
50
This class of antidepressants has a higher potential for cardiac arrhythmias, especially at higher doses
SNRIs
51
SNRIs may have dose dependent increase in this
BP
52
Severe withdrawal noted even after missing a single dose noted for this SNRI
Venlafaxine
53
Mirtazapine is this type of drug
Tetracycline
54
Mirtazapine blocks these two receptors to increase release of serotonin and norepinephrine
Alpha-2 and serotonin-2 receptors
55
Antidepressant that blocks presynaptic alpha-2 and serotonin-2 receptors to increase release of serotonin and norepinephrine
Mirtazapine (a tetracycline)
56
Mirtazapine blocks presynaptic alpha-2 and serotonin-2 receptors to increase release of these two compounds
Serotonin and norepinephrine
57
Antidepressant that blocks uptake of dopamine with less effect on norepinephrine
Bupropion
58
What is the MOA of Mirtazapine?
Blocks presynaptic alpha-2 and serotonin-2 receptors to increase release of serotonin and norepinephrine
59
What is the MOA of Bupropion?
Blocks uptake of dopamine
(less effect on norepinephrine)
60
What effect does Mirtazapine have on norepinephrine?
Increases release
61
What effect does Mirtazapine have on serotonin?
Increases release
62
What effect does Bupropion have on dopamine?
Blocks uptake
63
What effect does Bupropion have on norepinephrine?
Less effect
64
Antidepressant that has little interaction with ethanol
Bupropion
65
Antidepressant that has a high incidence of seizures, especially in patients with bulimia or when dose exceeds 450 mg/day
Bupropion
66
Bupropion has a high incidence of seizures, especially in patients with this condition
Bulimia
67
Bupropion has a high incidence of seizures, especially when dose exceeds this
450 mg/day
68
Incidence of psychosis has been noted with this antidepressant
Also may be stimulating (so should be given early evening)
Bupropion
69
Trazodone is this type of drug
Heterocyclic antidepressant
70
Nefazodone is this type of drug
Heterocyclic antidepressant
71
Heterocyclic antidepressants block this receptor
Presynaptic serotonin receptors
(to promote release)
72
What effect do Heterocyclic antidepressants have on serotonin?
Promote release
73
Heterocyclic antidepressant with hepatotoxicity
Nefazodone
74
Heterocyclic antidepressant with side effect of persistent erection (pripism) in men and women
Trazodone
75
What is the primary action of Vortioxetine?
Serotonin reuptake inhibitor
76
Vortioxetine is an agonist of this receptor
5-HT1a
77
Vortioxetine is an antagonist of these two receptors
5-HT3 and 5-HT7
78
Drug that is a serotonin reuptake inhibitor (primary action), 5-HT1a agonist, and 5-HT3 and 5-HT7 antagonist
Vortioxetine
79
Primary adverse effects of this non-pharmacological therapy for depression are confusion, memory loss and delirium
ECT (electroconvulsive therapy)
80
SSRI with a long lasting metabolite
Fluoxetine
81
Side effects of this class of antidepressants includes GI disturbance, sexual dysfunction, anxiety rebound
Risk of withdrawal and serotonin syndrome
SSRI
82
Side effects of this class of antidepressants include increase in BP, risk of cardiac arrhythmias, severe withdrawal potential
SNRI
83
Side effects of this antidepressant include high level of sedation and marked stimulation of appetite
Mirtazapine
84
What effect does Mirtazapine have on appetite?
Increases
85
This antidepressant has low incidence of sexual side effects, and is mildly stimulating (amphetamine like mechanism)
Bupropion
86
Antidepressant that has some risk of psychosis with long term use
Bupropion
87
Class of antidepressants with MOA presumed to be related to blockade of norepinephrine uptake processes
Tricyclic antidepressants
88
The MOA of Tricyclic antidepressants is presumed to be related to blockade of this process
Norepinephrine uptake
89
Protein binding of this class of antidepressants is very sensitive to changes in pH
Tricyclic antidepressants
90
Class of antidepressants with antimuscarinic effects and alpha-1 blockade effects
Tricyclic antidepressants
91
Class of antidepressants that is a direct cardiac depressant
Arrhythmias and QT prolongation
Tricyclic antidepressants
92
Class of antidepressants with side effects of toxic delirium, seizures, and weight gain
Tricyclic antidepressants
93
If acidosis occurs, protein binding of this class of antidepressants decreases
Tricyclic antidepressants
94
With Tricyclic antidepressants, if acidosis occurs, does protein binding increase or decrease?
Decreases
95
In Tricyclic antidepressants overdose, acidosis may occur, resulting in decreased protein binding. This should be treated with alkalization, with these two things:
Hyperventilation
Sodium bicarbonate
96
Class of antidepressants that interacts with central nervous depressants, sympathetic agents, MAOIs, and anticholinergics
Tricyclic antidepressants
97
Imipramine is this type of drug
Tricyclic antidepressants
98
Maprotiline is this type of drug
Tricyclic antidepressant
99
Clomipramine is this type of drug
Tricyclic antidepressant
100
Amitriptyline is this type of drug
Tricyclic antidepressant
101
Doxepin is this type of drug
Tricyclic antidepressant
102
Long-term treatment of depression, enuresis of childhood, and pain management are indications for this class of antidepressants
Tricyclic antidepressants
103
Therapeutic blood monitoring should occur with this class of antidepressants because of narrow range between effective and toxic doses
Tricyclic antidepressants
104
Class of antidepressants generally used only for patients not responding to other safer therapies and should be prescribed by a specialist mental health professional
Monoamine oxidase inhibitors
105
Isocarboxazid is this type of drug
Monoamine oxidase inhibitor
(irreversible)
106
Phenelzine sulfate is this type of drug
Monoamine oxidase inhibitor
(irreversible)
107
Tranylcypromine is this type of drug
Monoamine oxidase inhibitor
(irreversible)
108
Monoamine oxidase inhibitor that has direct receptor agonist actions
Tranylcypromine
109
Drug that is an irreversible inhibitor of MAO-B
Selegiline
110
Selegiline is an irreversible inhibitor of this
MAO-B
111
Common adverse effects of this class of antidepressants include tremors, sexual dysfunction, and orthostatic hypotension
Monoamine oxidase inhibitors
112
Does orthostatic hypo- or hyper-tension occur with Monoamine oxidase inhibitors?
Hypotension
113
This drug is a near absolute contraindication of Monoamine oxidase inhibitors due to risk of malignant hyperthermia
Meperidine
114
Meperidine is a near absolute contraindication of this class of antidepressants due to risk of malignant hyperthermia
Monoamine oxidase inhibitors
115
Meperidine is a near absolute contraindication of Monoamine oxidase inhibitors due to risk of this
Malignant hyperthermia
116
Class of antidepressants that interacts with any sympathetic agents, and can cause a hypertensive crisis
Monoamine oxidase inhibitors
117
Class of antidepressants with antihistamine effects including sedation and weight gain
Tricyclic antidepressants
118
In overdose of Tricyclic antidepressants, this should be monitored
pH
119
In overdose of this class of antidepressants, serum pH should be monitored
Tricyclic antidepressants
120
NMDA receptor blocker that is approved for treatment-resistant depression
Esketamine
121
Esketamine is a blocker of this receptor
(is approved for treatment-resistant depression)
NMDA
122
Does bipolar disorder occur more commonly in females or males?
Similar occurrences in males and females
123
What is the age of onset of bipolar disorder?
Early 20s
124
Does this describe Bipolar I or II:
One manic (as opposed to hypomanic episode) lasting 7 or more days
May or may not have a major depressive episode
Bipolar I
125
Does this describe Bipolar I or II:
Must have had a major depressive episode lasting at least 2 weeks and 1 hypomanic episode
Often initially misdiagnosed as MDD, as hypomania is rarely presenting symptom
Bipolar II
126
This mood stabilizer can be used to treat bipolar disorder, and requires monitoring for therapeutic dose and kidney function
Associated with low thyroid function, joint pain, indigestion
Lithium
127
Is electroconvulsive therapy effective at treating the manic or depressive state of bipolar disorder?
Both
