Treatment Resistant Depression Flashcards
Treatment-resistant depression definition
Non-response to 2 separate trials of different ADs that had adequate doses and durations
What to do in treatment-resistant depression
switch to an alternate AD class where you can cross-titrate it or just D/C the med and start a new one
Treatment-resistant combinations used
SSRI or SNRI + bupropion or mirtazapine
SSRI and TCA
Augmentation agents
lithium, triiodothyronine, SGAs
Augmentation agents: lithium
First line augmentation strategy
Augmentation agents: triiodothyronine
Used in augmentation regardless of thyroid status
Monitoring of triiodothyronine
TSH, bone density, signs and Sx of hyperthyroidism
SGAs used in augmentation
aripiprazole, brexipiprazole, quetiapine, olanzapine/fluoxetine
SGA monitoring for augmentation
Metabolic effects
Non-pharm options for treatment-resistant depression
Psychotherapy, ECT, vagal nerve stimulation, transcranial magnetic stimulation, bright light therapy
Spravato (esketamine) Na in treatment-resistant depression
Used in combination with a PO AD
Spravato CI
Aneurysmal vascular disease, intracerebral hemorrhage
Spravato ADEs
increased BP, cognitive impairment, impaired ability to drive or operate machinery, embryo-fetal toxicity, dissociation, dizziness, N/V, sedation, vertigo, hypoesthesia, anxiety, lethargy, feeling drunk, incontinence, decreased urinary frequency
Spravato BBW
sedation, dissociation, abuse and misuse (it’s a CIII), suicidal thoughts and behaviors
Spravato in the REMS program
Has to be administered in direct observation of a HCP
Monitored for 2 hours after administration
Pharmacies, doctors, and patients must enroll in REMS program
