What is the risk of relapse after first MDD episode? After 3 episodes?
one episode = 50% recurrence
3 episodes = >80% recurrence
Why get an EKG with neuroleptics, Lithium and TCAs?
NEUROLEPTICS = increased PR and tornadoes/ventricular arrhythmia.
LITHIUM = supraventricular arrhythmia > Ventricular arrhythmias.
TCAs = Increased PR, Qtc, QRS and potential for AV block and sudden death.
After remission from a single MDD episode, how long should you continue treatment (continuation phase) ?
6-12 months at same dose AFTER full remission is reached.
What are the indications for ECT?
Severe depression +
- Psychosis
- Patient preference
- Prior good response to ECT
- Fast response needed (high suicide risk, not eating/drinking, catatonic)
- Treatment failure or intolerant to medications
What is considered treatment resistant depression?
Not responsive to 2 full trials of medications
What is the difference between RESPONSE and REMISSION of depressive symptoms?
RESPONSE = 50% reduction in symptoms
REMISSION = minimal residual symptoms (7 or less on HAM-D)
What is the consensus expert opinion on what antidepressant to switch to if SSRI fails in the following situations?
Anxiety is prominent?
Apathy is prominent?
Insomnia/Anxiety are prominent?
Melancholic?
Anxiety is prominent = Venlafaxine
Apathy is prominent = Bupropion
Insomnia/Anxiety are prominent = Mirtazapine
Melancholic = Nortriptyline
What are the common augmentation strategies to antidepressants?
- Abilify (FDA)
- Quetiapine (FDA)
- Brexpiprazole (FDA)
- Lithium (STAR-D)
- T3 (liothyronine) STAR-D
- Methylphenidate
Duloxetine should be avoided in what three patient populations?
- Significant etoh use disorder
- Chronic hepatic disease
- Severe renal disease
What are there SRI modulator antidepressants and what is their exact MOA?
- Trazodone: SRI + 5-HT1A partial agonist
- Vilazodone: SRI + 5-HT1A partial agonist
- Vorioxetine: SRI + 5-HT1A partial agonist + 5-HT3 and 5-HT7 antagonist
