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1

What are the starting doses of SSRIs?

Fluoxestine 20mg
Paxil 20mg
Zoloft 50mg
Fluvox 50mg
Celexa 20mg
Lexapro 10mg

2

What are the starting doses of SNRIs?

Effexor 37.5-75mg
Cymbalta 30-60mg

3

What is the starting dose of mirtazapine?

15mg

4

What is the starting dose of wellbutrin?

100-150mg

5

What is the duration of MDD therapy?

4-8 weeks

6

What is the diagnostic criteria for MDD?

2+ weeks
5+ sx

7

What are the sx of MDD?

Sleep (insomnia/hypersomnia)
Interest (loss of interest/pleasure)
Guilt (feeling of worthlessness; excessive/inappropriate guilt)
Energy (Fatigue/loss of energy)
Concentration
Appetite (change in appetite/wt)
Psychomotor
Suicidal thoughts
Low mood

8

What is the diagnostic criteria for mania?

3+ sx
1+ week
Or any duration if hospitalization is necessary
Cause marked impairment

9

What is the diagnostic criteria for hypomania?

3+ sx
4+ consecutive days
Not severe enough to cause marked impairment

10

What are the sx of mania/hypomania?

Grandiose; increase self-esteem
Increased activity (goal directed/highly risky)
Decreased judgement
Distractibility; flight of ideas
Irritability
Need less sleep
Elevated mood
Speedy talking/thoughts

11

What are the diagnostic criteria for rapid cycling?

4+ mood episodes (MDD, manic, mixed, hypomanic)/year

12

What are the criteria for cyclothymia?

Numerous periods with hypomanic sx and depressive sx for at least 2 years that do not meet criteria for MDD
For more than 2 months at a time
Present for at least 1/2 the time

13

What is the criteria for mixed BD?

Patient w/sx of both mania and depression simultaneously

14

What are the characteristics of BP I?

Mania
Psychosis often present
Impaired functioning
Hospitalization often required
Duration = months

15

What are the characteristics of BP II?

Hypomania
Psychosis often not present
Slightly impaired to improved functioning
Hospitalization not required
Duration = weeks

16

What are the first line therapy for MDD?

SSRI
SNRI
Mirtazapine
Bupropion

17

What are the first line therapy for acute mania?

Lithium
VPA
SGA
Consider 2 drug combination, if severe (MS + SGA)
CBZ 1st or 2nd line depending on guideline

18

What are the first line therapies for BD?

Lithium
Lamictal
Quetiapine

19

What are the first line therapies for Mixed BD?

CBZ
VPA
Olanzapine

20

What length of time is considered an adequate trial before adjusting/augmenting MDD therapy?

4-8 weeks

21

What do we do if a patient with MDD is non-responsive to therapy?

Change/switch to a drug in a different/same class

22

What do we do if a patient with MDD is partially responsive to therapy?

Ensure optimized dose
Can switch/augment
Augment/adjunctive therapy should target remaining sx
Augmentation is better strategy when response is seen

23

What is the gold standard for augmentation in partial response for MDD?

Lithium

24

What drugs are options for MDD augmentation/adjustments?

AAP (low dose SGAs in MDD w/o psychosis)
Anticonvulsants
Omega-3
Folic acid
Psychostimulants
Buspar
Ketamine

25

Where is psychostimulants in MDD partial response therapy?

Controversial
May consider short course if severe depression (fatigue, not getting out of bed or if immediate response required)
May exacerbate anxiety
Abuse potential

26

What is the DOT of MDD?

12 months with the first episode for most patients
12-26 months for patients w/recurrent and/or severe MDD
Potentially indefinitely depending on severity

27

What is the DOT of BD?

Typically lifelong

28

Which medication decreases SI in MDD?

Lithium

29

Which screening tool in MDD is used for screening?

PHQ-9

30

Who gets PHQ-9 and HAM-D?

All adults at least every 5 years
Those at high risk