Depression

Question 1

What are the SSRI agents?

Answer 1

• Citalopram
• Escitalopram
• Fluoxetine
• Fluvoxame
• Paroxetine
• Sertraline

Question 2

What are the SNRI agents?

Answer 2

• Duloxetine
• Desvenlafaxine
• Levomilnacipram
• Venlafaxine
• Milnacipram

Question 3

What are the TCA agents?

Answer 3

• Amtriptylline
• Amoxapine
• Clomipramine
• Desipramine
• Doxepin
• Imipramine
• Maprotiline
• Trimipramine
• Nortryptylline
• Protriptyline

Question 4

What are the MAOIs?

Answer 4

• Phenelzine
• Selegeline
• Rasagiline
• Tranylcypromine

Question 5

What are the miscellaneous agents for depression?

Answer 5

• Bupropion
• Brexanolone
• Esketamine
• Mirtazapine

Question 6

What SSRIs are FDA-recommended for MDD

Answer 6

• Citalopram
• Escitalopram
• Fluoxetine
• Paroxetine
• Sertraline

Question 7

What are your first line medications for depression?

Answer 7

• SSRI
• SNRI
• Bupropion
• Mirtazapine
• Vortioxetine

Question 8

What should you do if symptoms persist after 4 - 8 weeks?

Answer 8

Switch to alternate AD
Augment with alternative MOA, 2nd gen APS or Psychotherapy

Question 9

What are the two main MDD Rating Scales?

Answer 9

HAM - D
MADRS

Question 10

What should you do if you see a an extreme response less than 2 weeks?

Answer 10

Watch. D/C, taper due to manic switch

Question 11

Counseling symptoms for Serotonin Syndrome

Answer 11

Mental Status Changes
Autonomic instability
Neuromuscular abnormality
GI symptoms

Question 12

Issues/Adverse Effects of SSRIs

Answer 12

QTc prolongation w/ concomitant meds
Increased risk of bleeding (NSAIDs/plates/anticoags)
Hyponatremia
Sexual side effects
Withdrawal Syndrome
Hepatic Impairment

Question 13

True or False. With SSRIs, dose modifications are common and are required for renal impairment

Answer 13

False. With SSRIs, there’s caution/dose modification with hepatic impairment

Question 14

True or false. SSRIs are more sedating than energy boosting.

Answer 14

False. The other way around

Question 15

Which SSRI is available as ODT?

Answer 15

Citalopram

Question 16

What is the dosing of Citalopram in older adults?

Answer 16

20 mg

Question 17

What is one of the most sedating SSRIs and also can be anticholinergic and is cautioned in the elderly?

Answer 17

Fluvoxamine

Question 18

What is the only SSRI approved for once weekly admin?

Answer 18

Fluoxetine

Question 19

What is the Drug Interaction for Fluvoxamine?

Answer 19

CYP1A2

Question 20

What SSRI is available as a liquid?

Answer 20

Fluoxetine

Question 21

For which population is Citalopram 20 mg required?

Answer 21

• 60 years old plus
• CYP2C19 Poor Metabolizers
• Hepatic impairment

Question 22

What dose is required for Escitalopram in the hepatically impaired?

Answer 22

10 mg

Question 23

What population should be cautious or avoid paroxetine?

Answer 23

Avoid in the elderly
Avoid in pregnancy

*Reports of bone fracture

Question 24

What is the most common drug-drug interaction with SSRIs?

Answer 24

CYP2D6

Question 25

Side effects of SNRIs

Answer 25

Abnormal bleeding (5HT reuptake on platelets) Elevated blood pressure Hyponatremia 5HT Syndrome Discontinuation Syndrome

Question 26

True or False. SNRIs are more energy boosting than other antidepressants.

Answer 26

True

Question 27

What SNRIs are indicated for Depression (MDD)?

Answer 27

Duloxetine Desvenalfaxine Venlafaxine Levomilnacipram

Question 28

Should you give Venlafaxine with food?

Answer 28

Yes

Question 29

What is the dual diagnosis with Duloxetine?

Answer 29

Depression Pain

Question 30

In what populations should you avoid use of Duloxetine?

Answer 30

Hepatic Dysfunction ESRD

Question 31

What TCAs are used in Depression?

Answer 31

All but Clomipramine

Question 32

What is the dual diagnosis with Doxepin?

Answer 32

Depression Insomnia

Question 33

MAOIs Precaution with Washout

Answer 33

Must wait 4 - 5 half lives of drug/active metabolite (usually 2 weeks)

Question 34

Washout period for Fluoxetine

Answer 34

5 weeks

Question 35

Washout period fro Vortioxetine

Answer 35

3 weeks

Question 36

Dietary restrictions with MAOIs

Answer 36

Tyramine containing foods and can lead to hypertensive crisis

Question 37

What formulation does Selegline come in?

Answer 37

Patch ***9 -12 mg - implement diet restrictions

Question 38

What are your antidepressant Serotonin Modulators?

Answer 38

Nefadozone Trazodone Vilazodone VortioxetineAISIG