Term
| First line for Depression - SSRIs Time of onset ? Common side effects? 2nd line |
|
Definition
| First line for Depression - SSRIs 2-4 week onset GI upset, sexual dysfunction. CNS effects eg agitation |
|
|
Term
Second line for Depression
Which drugs to use ? When to use them?
Contraindications of bupropion?
Which antipsychotic is the only one approved for use in depression |
|
Definition
Second line for Depression
If fail or sensitive to SSRI treamtment use bupropion, mirtazapine, moclobemide, trazodone, Quetiapene
Contraindications of bupropion: Seizure, anorexia, head trauma
Quetiapine is the only antipsychotic approved for use in depression |
|
|
Term
Trazodone
Mechanism ?
Side effects
Interactions |
|
Definition
Trazodone - 2nd line option (along with many others) for depression following SSRI failure/sensitivity
postsynaptic serotonin antagonist
Side effects: High sedation, causes priapism, lowers BP
Interactions: can potentiate CNS depressants, avoid use with MAOIs |
|
|
Term
Mirtazapine
Side effects:
Interactions: |
|
Definition
Mirtazapine
Side effects: Weight gain, & sedation
Interactions: Serotonergic, avoid use with MAOIs |
|
|
Term
| **REFER TO ANXIETY PACKET (chapter 2)FOR MORE ABOUT SPECIFIC CLASSES** |
|
Definition
| **REFER TO ANXIETY PACKET (chapter 2)FOR MORE ABOUT SPECIFIC CLASSES** |
|
|
Term
| What herbal product can be used monotherapy for mild/moderate depression? |
|
Definition
| St. John's Wort can be used monotherapy for mild/moderate depression |
|
|
Term
| To prevent relapse of depression how long should maintenance therapy continue - after 1 depressive episode? after 2+ depressive episodes ? |
|
Definition
Maintenance:
After 1 depressive episode, treat for 1 year. After 2 depressive episodes, treat for 2 years. |
|
|
Term
How should antidepressants be discontinued?
Which antidepressants are most likely to cause discontinuation symptoms such as insomnia, dizziness, nausea and diarrhea ? |
|
Definition
| Slowly taper off antidepressants, especially paroxetine and venlafaxine |
|
|
Term
Treatment resistant depression
When should a switch be made within a class?
When should a switch be made to a drug outside of class ? |
|
Definition
Treatment resistant depression
Switch within a class when drug is efficacious but side effects are problematic
Switch to a different class when drug is not efficacious |
|
|
Term
Treatment resistant depression
Should antidepressants generally require a washout period ? How should the switch be conducted ? |
|
Definition
Treatment resistant depression
Antidepressants GENERALLY do not require a washout, and the switch can be conducted via the crossover technique
*THERE ARE EXCEPTIONS* - further slides |
|
|
Term
Some antidepressants require a washout period. What is the washout period required when switching from:
Any Antidepressants --> irreversible MAOIs |
|
Definition
Any antidepressants --> irreversible MAOIs
5 half-lives |
|
|
Term
Some antidepressants require a washout period. What is the washout period required when switching from:
irreversible MAOIs --> any antidepressants |
|
Definition
irreversible MAOIs --> any Antidepressants
2 week washout |
|
|
Term
Some antidepressants require a washout period. What is the washout period required when switching from:
moclobemide --> Antidepressants |
|
Definition
5 days for switching from
moclobemide --> Antidepressants |
|
|
Term
Some antidepressants require a washout period. What is the washout period required when switching from:
Fluoxetine --> irreversible MAOIs |
|
Definition
**5 week washout**
Fluoxetine --> irreversible MAOIs |
|
|
Term
What agent can be used in addition to an antidepressant that had a partial response and favourable tolerablity ?
How about when insomnia/anxiety persist in depression? |
|
Definition
Lithium Carbonate (600-900mg daily) can be used in addition to antidepressants to augment therapy.
SGAs - Q,O,A,R are particularly useful in augmenting therapy in depressed patients who experience insomnia/anxiety. |
|
|
Term
Which antidepressant is associated with congenital abnormalities when used in the first trimester ?
Which class is associated with pulmonary hypertension when used during the 3rd trimester?
Which SSRIs are considered safe in nursing mothers?
Which TCA is considered safe in nursing mothers? |
|
Definition
Paroxetine --> Congenital abnormalities 1st trimester
SSRIs --> pulmonary HTN when used in 3rd trimester
Paroxetine & Sertraline --> Safe in nursing mothers.
Nortriptyline --> Safe in nursing mothers. |
|
|
