Psych Flashcards
(26 cards)
Risk factors for MDD
Family history
Female
Peak onset 20s
Diagnostic criteria for depression
at least 2 episodes of >5 associated symptoms for most days for 2 weeks
depression or anhedonia
Sleep
Irritability
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal
When would ECT be used for depression
unresponsive to medical therapy, unable to tolerate pharmacotherapy, or rapid reduction in patients with severe symptoms
Safe in pregnancy and elderly
What is the only FDA approved antidepressant to treat bulimia
Fluoxetine (lowest risk of weight gain)
Adverse effects of SSRIs
GI distress (nausea)
Headache
Sexual dysfunction
CNS stimulation: anxiety, insomnia, SIADH, serotonin syndrome
Increased suicidality in children and young adults <25 yo
Treatment options for sexual dysfunction due to SSRI
lower antidepressant dose
switch to another antidepressant (eg bupropion, mirtazapine)
augment with either bupropion or PDE-5 inhibitor
Which SSRI has the most sexual dysfunction, antihistaminic activity and more significant anticholinergic activity (can cause more dry mouth, dizziness, and weight gain)
Paroxetine
Which SSRI especially causes QT prolongation
Citalopram
What are norepinephrine symptoms in SNRIs
sweating, dizziness, dry mouth, constipation
hypertension
Contraindications/cautions to SNRIs?
MAOI use
renal or hepatic impairment
seizures
Avoid abrupt discontinuation
caution with hypertension or glaucoma
increased risk of serotonin syndrome with SNRIs and St John’s Wort
Adverse effects of bupropion
Lowered seizure threshold
CNS stimulant like adverse effects
nausea, increased psychosis at high doses
Contraindications to bupropion
epilepsy or conditions with increased seizure risk (eating disorders, bulimia, anorexia)
What are the TCAs
Amitriptyline
Clomipramine
Imipramine
Doxepin
Amoxapine
Desipramine
Nortriptyline
Maptrotiline
MOA of TCAs
Inhibit reuptake of serotonin and norepinephrine
competitive antagonists on post-synaptic alpha-adrenergic, muscarinic, and histaminergic receptors
Which TCA is FDA approved for OCD
clomipramine
Which TCA can be used for nocturnal enuresis after the failure of desmopressin in children?
Imipramine
TCA overdose
Anticholinergic symptoms: tachycardia, dry mouth, mydriasis, hyperreflexia, warm flushed dry skin, hyperthermia, GI complaints, urinary retention, confusion, agitation
3 C’s: cardiotoxicity (wide complex tachycardia), convulsions, and coma
Management of TCA overdose
Cardiotoxicity: IV sodium bicarbonate Seizures: benzos
Which TCA is useful in neuropathies and chronic pain (can also be used in insomnia)
amitriptyline
Which TCA is good for chronic pain and is a sleep aid in low doses
doxepin
which TCA is the least sedating and least anticholinergic
desipramine
which TCA is good for chronic pain and is the best tolerated, especially in the elderly? It is also the least likely to cause orthostatic hypotension
Nortriptyline
Indications for mirtazapine
depression, especially in patients with insomnia or significant weight loss (also has fewer sexual adverse effects)
anxiety disorders (may be used with trazodone)
adverse effects of mirtazapine
antihistaminic: drowsiness, sedation most common, weight gain (appetite stimulant)
dry mouth, constipation, tremor, dizziness, and agranulocytosis
increased risk of suicidality in children, adolescents, and young adults
