Depression

Question 1

How to treat mild depression

Answer 1

cognitive behaviour therapy

Question 2

How to treat moderate to severe depression

Answer 2

Antidepressants

Question 3

How long do you need to take Antidepressants for it to be deemed ineffective

Answer 3

4 weeks

(as the first 1 to 2 weeks symptoms might get worse)

Question 4

How long do you need to take Antidepressants for it to be deemed ineffective for ELDERLY

Answer 4

6 weeks

Question 5

How long after remission should you still be taking Antidepressants

Answer 5

6 months
(1 year in elderly and recurrent depression)

Question 6

What is the 1st and 2nd Line treatment for Depression

Answer 6

1st Line:
SSRI

2nd Line:
- increase dose
- change SSRI
- TCA
- Venlafelaxine
- Mirtazapine

Question 7

What is the 3rd and 4th Line treatment Line for Depression

Answer 7

3rd Line:
+ Lithium / Antipsychotics

4th Line:
Electrocompulsive Therapy

Question 8

What is the 1st Line medication for Depression for a paitent who is =<17 years

Answer 8

Fluoxetine

Question 9

If a patient is at risk of bleeding and needs to be treated for depression, what medication would you use

Answer 9

Mirtazapine

Question 10

What is the most suitable medication for depression for patients who have cardiac events

Answer 10

Sertraline

(SSRIs)

Question 11

Which SSRIs induce QT prolongation

Answer 11

Escitalopram nd Citalopram

Question 12

Side Effects of SSRIs

Answer 12

• GI disturbances
• Weight gain
• Sexual dysfunction
• risk of bleeding
• Insomnia (take it in the morning)

Question 13

Interactions of SSRIs

Answer 13

• CYP450 inducers and inhibitors
• drugs that cause QT prolongation
• drugs that increase risk of bleeding
• drugs that cause hyponatraemia
• drugs that cause serotonin syndrome

Question 14

Which drugs cause serotonin syndrome

Answer 14

• SSRI
• TCA
• MAOaI
• Triptans
• Tramadol
• Lithium

Question 15

What 3 types of side effects can serotonin syndrome cause

Answer 15

• Cognitive
• Autonomic
• Neuromuscular

Question 16

What are cognitive side effects

Answer 16

• confusion
• coma
• headache
• agitation

Question 17

What are Autonomic side effects

Answer 17

• sweating
• nausea
• hyperthermia
• Diarrhoea

Question 18

What are Neuromuscular side effects

Answer 18

• termour
• teeth grinding
• myoclonus (sudden muscle contractions)

Question 19

Examples of Sedating Tricyclic Antidepressants

Answer 19

• Amitriptyline
• Clomipramine
• Dosuleptin
• Trazodone

Question 20

Examples of Less-Sedating Tricyclic Antidepressants

Answer 20

• Imipramine
• Lofepramine
• Nortriptaline

Question 21

Which 2 Tricyclic Antidepressants are not recommended in Depression and why

Answer 21

• Amitriptyline
• Dosuleptin

because they are dangerous in overdose

Question 22

Side effects of Tricyclic Antidepressants

Answer 22

• dry mouth, dehydration (anti-muscarinic)
• hypotension
• hallucinations
• cardiac events

Question 23

Interaction of Tricyclic Antidepressants

Answer 23

• CYP450 inhibitors and Inducers
• drugs that cause QT prolongation
• anti-muscarinic drugs
• anti-hypertensive
• drugs that cause serotonin syndrome

Question 24

Which foods should you avoid with Monoamine Oxidase-A Inhibitors

Answer 24

Tyramine rich foods

Question 25

Which OTC product should you avoid with Monoamine Oxidase-A Inhibitors and why

Answer 25

- Pseudoephedrine because MAOi cause hypertensive crisis

Question 26

What toxicity do Monoamine Oxidase-A Inhibitors cause

Answer 26

Hepatotoxicity

Question 27

Examples of Monoamine Oxidase-A Inhibitors

Answer 27

- Selegiline - Isocarboxazid - Phenelzine - Tranylcypromine

Question 28

Clomipramine(TCA) + Tranylcypromine(MAOi) Interaction

Answer 28

Fatal (AVOID)

Question 29

How long should you wait between taking these medication: Clomipramine/Imipramine(TCA) + Tranylcypromine(MAOi)

Answer 29

3 weeks

Question 30

How long should you wait to start other Antidepressants after taking MAOi

Answer 30

2 weeks

Question 31

How long should you wait to start taking MAOi after stopping other MAOi

Answer 31

2 weeks

Question 32

How long should you wait to start taking MAOi after stopping TCAs

Answer 32

1 to 2 weeks

Question 33

How long should you wait to start taking MAOi after stopping SSRIs

Answer 33

1 week

Question 34

How long should you wait to start taking MAOi after stopping Fluoxetine

Answer 34

5 weeks

Question 35

Why does there need to be a gap between different Antidepressants and MAOi

Answer 35

Because MAOi need a washout period