PSY - Depression
Terms in this set (43)
What is dysthymia?
- Persistent depressive disorder (at least 2 yrs)
- Sx are fewer and less severe vs. MDD
How is depression diagnosed?
at least 5 of the SADAFACES sx have to be present for 2 wks
+ functional impairment
Psychotherapies are as effective as medication for depression of mild to moderate severity.
adjuncts: light therapy, exercise
T/F: It may take
to see a noticeable effect from antidepressants.
Which 4 ADs have superior efficacy?
- escitalopram, mirtazapine, sertraline and venlafaxine
after taking into account drop-outs:
- escitalopram, sertraline, bupropion and citalopram
escitalopram and sertraline
are 2 of the most effective and well-tolerated options
Name 3 second-line agents
Unlike GI or CNS side effects, sexual dysfunction is more likely to persist during SSRI therapy.
How does sexual dysfx present?
impairment of desire, arousal and/or orgasm/ejaculation
Name 3 ADs that cause less sexual dysfx
bupropion, mirtazapine, moclobemide
Which AD has been effective in n peri- and postmenopausal women?
Describe the difference in the MOA between duloxetine and venlafaxine
- affects serotonin at all doses
- affects NE reuptake at doses > 150 mg
- hypertensive effects at doses > 225 mg
Duloxetine: affects both 5HT and NE at the starting dose of 60 mg
is an SNRI with higher potency for NE than 5HT reuptake
Name 2 contraindications of bupropion
- seizure disorder -> caution in hx of head trauma
- anorexia or bulimia nervosa
Describe the MOA and dosing of
- MOA: postsynaptic serotonin (5HT2) receptor antagonist; doesn't affect reuptake as much
- Antidepressant doses 300-400 mg daily
- Hypnotic/adjunct doses: 50-100 mg
note: does not cause tolerance unlike BZDs
What is the MOA of
? What is it's advantage?
- MOA: direct 5-HT receptor modulation & serotonin transporter (SERT) inhibition
- Helps improve cognition/neuropsychological performance
Which TCA is the most serotonergic and is used in the tx of OCD?
does not require the same dietary restrictions as irreversible MAOIs.
true; a well-tolerated alternative to SSRI or SNRI agents
When does AD Discontinuation Syndrome more often occur?
- if taking AD for > 6 wks
- most common with SSRIs
- when taking short-acting agents
What are 2 short-acting ADs that increase the risk of Discontinuation Syndrome?
Which AD has a long half-life and can be tapered more rapidly than other SSRIs?
fluoxetine, vortioxetine -> less risk of D/C Syndrome
What is the timeframe of D/C Syndrome?
- starts within 1-7 days of stopping AD
- If untreated, Sx will subside within 3 days to 3 weeks
What are Sx of the D/C Syndrome? (hint: FINISH)
o Flu-like symptoms
o Sensory disturbances
Name a Pro and Con of
St. John's wort
Pro: effective; can use for mild-mod. MDD
Con: inducer of CYP3A4 and Pgp
SE: insomnia, agitation, photosensitivity
Name 2 other NHPs used of mild depression
- S-adenosylmethionine (SAM-e) -> SE: insomnia, constipation, additive
- L-methylfolate (adjunct)
What is the min. recommended duration of AD therapy?
9 months after achieving remission
- For pts at risk of recurrence, tx for at least 2 yrs
T/F: Consider switching
a class of AD in the presence of a favourable clinical response hampered by unmanageable SE
How should AD agents be switched?
- Generally there is no need for a washout period
- Use a crossover technique
Exception: 2 wk wash-out for MAOI (5 wks if going from fluoxetine to aMAOI)
augmentation or combination therapy
- when a patient tolerates the first AD but has only a partial response
- moderate-severe depression, or refractory depression
What are the adjuncts used in augmentation?
- SGAs: aripiprazole, olanzapine, quetiapine and risperidone
- Bupropion (with SSRIs)
Modafinil and Methylphenidate
-> enhance motivation and energy
A combination of pharmacotherapy and psychotherapy is superior to either modality alone.
ADs provide more rapid relief of Sx, but don't prevent relapse if stopped, unlike psychotherapy which has long-term effects
Which SSRI should be AVOIDED in
note: 3rd trim. SSRI exposure may increase risk of pulmonary hypertension in the newborn
Which SSRIs are preferred in
sertraline, escitalopram or citalopram
Can quetiapine be used as monotherpay in depression?
yes; officially indicated for depression
Name 3 SE of MAOIs
- Postural hypotension
- Sexual dysfunction
What are 2 important SE of citalopram and escitalopram?
- QTc prolongation
Name 2 SE of fluoxetine
unlike fluvoxamine which causes anorexia & sedation
Name a SE of fluvoxamine
Name 2 SE of paroxetine
- constipation, dry mouth
Name 2 SE of sertraline
Which AD should not be used in renal dysfx (ClCr <30 mL/min)?
Name 2 SE of vortioxetine
Which AD can lower seizure threshold?
What are some SE of TCAs?
- antihistaminergic (sedation, weight gain)
- osthostatic hypotension
- sexual dysfx