Depression

Question 1

What symptoms are included in the DSM-5 criteria for depression?

Answer 1

M SIG ECAPS
Mood
Sleep
Interests
Guilt
Energy
Concentration
Appetite
Pleasure
Suicidal ideation

Question 2

Drugs that cause/worsen depression

Answer 2

Atomoxetine, antidepressants, benzodiazepines, ethanol, varenicline
Hormonal contraceptives, steroids (anabolic, systemic)
Beta-blockers (esp propranolol)
Interferons, efavirenz, rilpivirine
Indomethacin

Question 3

Natural products for depression

Answer 3

St. John’s wort
SAMe
5-HTP

Question 4

Preferred treatment for pregnancy, and what to avoid using

Answer 4

psychotherapy, escitalopram, citalopram
avoid paroxetine

Question 5

Preferred treatment for cardiac risk

Answer 5

sertraline

Question 6

Preferred treatment for smokers

Answer 6

bupropion

Question 7

Preferred treatment for peripheral neuropathy/pain

Answer 7

duloxetine

Question 8

Preferred treatment to prevent daytime sedation, and what to avoid using

Answer 8

use fluoxetine, bupropion
avoid paroxetine, mirtazapine, trazadone

Question 9

Preferred treatment if sexual dysfunction is a concern, and what to avoid using

Answer 9

bupropion, mirtazapine
avoid SSRIs/SNRIs

Question 10

Preferred treatment to prevent insomnia, and what to avoid using

Answer 10

use paroxetine, mirtazapine, trazadone, vilazodone, vortioxetine
avoid fluoxetine, bupropion

Question 11

Safety issues for all antidepressants

Answer 11

do not use with MAO inhibitors, linezolid, IV methylene blue
serotonin syndrome
must taper over several weeks when discontinuing
must provide MedGuide (BBW suicidal ideation)

Question 12

Serotonin syndrome symptoms

Answer 12

severe nausea, diarrhea
dizziness, headache, agitation, hallucinations
tachycardia, muscle rigidity

Question 13

Lag effect for physical and psychological symptoms

Answer 13

physical: 1-2 weeks
psychological: 1+ months

Question 14

max dosing for Celexa

Answer 14

40 mg/day
20 mg/day in elderly (> 60 y.o.)

Question 15

max dosing for Lexapro

Answer 15

20 mg/day
10 mg/day in elderly (> 60 y.o.)

Question 16

Which SSRIs are also approved for premenstrual dysphoric disorder?

Answer 16

Prozac, Paxil, Zoloft

Question 17

SSRI and SNRI safety issues

Answer 17

SIADH/hyponatremia
fall risk (Beers criteria)
additive bleed risk
sexual dysfunction
sedation (highest with paroxetine)
insomnia (highest with fluoxetine)
nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, headache

SNRI only: increased HR and BP, dilated pupils, constipation

Question 18

Which antidepressants decrease tamoxifen effectiveness? Which agent to use instead?

Answer 18

Paxil, Prozac, Cymbalta

use Effexor instead

Question 19

Tricyclic antidepressant MoA

Answer 19

inhibit serotonin and NE uptake
block ACh and histamine receptors

Question 20

Which tricyclics are tertiary amines? which are secondary amines?

Answer 20

tertiary: amitryptyline, doxepin
secondary: nortryptyline

Question 21

Tricyclic antidepressants safety issues

Answer 21

QT prolongation (w/ overdose)
orthostasis, sedation, weight gain
anticholinergic effects: dry mouth, blurred vision, constipation, urinary retention

Question 22

drugs that are SSRI combined with another mechanism

Answer 22

vilazodone (Viibryd)
vortioxetine (Trintellix)

Question 23

Bupropion MoA

Answer 23

dopamine and norepinephrine reuptake inhibitor

Question 24

Max dose of bupropion

Answer 24

450 mg/day

Question 25

Bupropion safety issues

Answer 25

CI to seizure disorder, hx anorexia/bulimia Dry mouth, insomnia/restlessness, tremors, weight loss

Question 26

Which agents are MAOis

Answer 26

Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate) Selegiline transdermal patch

Question 27

MAOi contraindications

Answer 27

drugs that increase serotonin (linezolid, lithium, tramadol, opioids, St. John's wort) tyramine-rich foods: aged, fermented, pickled, smoked soy sauce, sauerkraut, yeast extract

Question 28

How long is the washout period when switching between antidepressants and MAOIs?

Answer 28

2-week washout (SSRI/SNRI, TCAs, Bupropion) 5-week washout (fluoxetine)

Question 29

Mirtazapine safety issues

Answer 29

increased appetite, sedation, weight gain, additive QT prolongation

Question 30

Trazadone safety issues

Answer 30

sedation, priapism, additive QT prolongation

Question 31

Nefazodone safety issues

Answer 31

hepatotoxicity, rarely used

Question 32

What is the APA guideline definition of treatment-resistant depression?

Answer 32

4-8 weeks of therapeutic dose and no improvement

Question 33

What are options to augment treatment-resistant depression?

Answer 33

Buspirone Antipsychotics (aripiprazole, quetiapine, olanzapine, brexpiprazole, cariprazine) Esketamine nasal spray - REMS only Lithium

Question 34

Antipsychotic safety issues

Answer 34

BBW: dementia-related psychosis in elderly quetiapine and olanzapine - sedation, weight gain, increased lipids and glucose aripiprazole - anxiety, insomnia, akathisia

Question 35

Which antidepressants can cause QT prolongation?

Answer 35

Tricyclics Mirtazapine Trazadone Citalopram, Escitalopram

Question 36

Venlafaxine is indicated for

Answer 36

depression peripheral neuropathy panic disorder GAD social anxiety disorder

Question 37

Duloxetine is indicated for

Answer 37

depression peripheral neuropathy fibromyalgia GAD chronic musculoskeletal pain

Question 38

What brands contain bupropion?

Answer 38

Wellbutrin Zyban - smoking cessation Contrave - weight management (also has naltrexone)