- acute SI (I) - psychotic features (I) - treatment-resistant depression (I) - medication intolerance (III) - catatonic features (III) - prior response to ECT (III) - rapidly deteriorating physical health (III) - pregnancy for any of the above (III) - patient preference (IV)

review points Flashcards by Mary Z

What are the first-line treatments for mild-mod depression in pregnancy?

CBT (I)

IPT (I)

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What are the second-line treatments for mild-mod depression in pregnancy?

Citalopram (III)
Escitalopram (III)
Sertraline (III)
[the same as during breastfeeding]

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What are the third-line treatments for mild-mod depression in pregnancy?

(all drugs are level III or IV)
Fluoxetine
Fluvoxamine

Duloxetine
Venlafaxine
Desvenlafaxine

Bupropion
Mirtazapine

TCAs (not clomipramine)

ECT (III)

Exercise, acupuncture, bright-light (II) Other therapies (IV)

Combo SSRI + CBT/IPT (IV)

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First line treatments in depression w/ breastfeeding

CBT or IPT (I)

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Second line treatments in depression w/ breastfeeding

Citalopram (II)
Escitalopram (II)
Sertraline (II)
[the same as during pregnancy]

SSRI + CBT/IPT (II)

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Third line treatments in depression w/ breastfeeding

Fluoxetine (II)
Fluvoxamine (II)
Paroxetine (II)
TCAs (not doxepin) (II)

Duloxetine (III)
Desvenlafaxine (III)
Venlafaxine (III)

Mirtazapine (III)
Bupropion (III)

ECT (III)

Other: therapies, bright light, exercise, acupuncture, behavioural activation

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First line treatment for peri-menopausal depression

Desvenlafaxine (I)

CBT (II)

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Second line treatment for peri-menopausal depression

transdermal estradiol (II)

citalopram (III)
escitalopram (III)

duloxetine (III)
venlafaxine (III)

mirtazapine (III)
quetiapine (III)

fluoxetine, sertraline, paroxetine, nortryptiline and Omega3 FAs (IV)

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Third line treatment for peri-menopausal depression

mindfulness cbt, supportive

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First line in LLD (CANMAT)

Duloxetine (I)
Mirtazapine (I)
Nortriptyline (I)

Citalopram (II)
Escitalopram (II)
Sertraline (II)

Duloxetine (II)
Desvenlafaxine (II)
Venlafaxine (II)

Voritoxetine (II)

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Second line in LLD

Nortriptyline (I)
Moclobemide (II)
Phenelzine (II)
Trazodone (II)
Quetiapine (II)
Bupropion (III)

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Augmentation in LLD

Augmentation is considered second line:
Aripiprazole (I)
Lithium (I)
Methylphenidate (II)

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In the CANMAT guidelines, which antidepressants have evidence for superior efficacy based on meta-analysis

Escitalopram
Citalopram
Sertraline
[same as meds for pregnancy and breastfeeding depression!]

Venlafaxine

Mirtazapine

Agomelatine

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CANMAT first line ADs (15 tot)
There are: 
- 6 SSRIs
- 4 SNRIs
- 5 other

Citalopram
Escitalopram
Fluoxetine
Sertraline
Paroxetine
Fluvoxamine

Duloxetine
Desvenlafaxine
Venlafaxine
Milnacipran

Vortioxetine 
Mirtazapine
Bupropion
Agomelatine
Milanserin

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CANMAT first line adjuncts (3)

Aripiprazole (I)
Quetiapine (I)
Risperidone (I)

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CANMAT second line adjuncts (7)

Brexipip (I)
Olanzapine (I)

Bupropion (II)
Mirtaz (II)

Lithium (II)
Modafinil (II)
T3 (II)

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Varenicline MOA

Partial agonist at α4β2 nAChR

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Bupropion MOA

Noradrenaline and dopamine reuptake inhibitor
Dose: 150-300 mg daily
Cyp 2D6 inhibitor

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Which patients need long-term depression treatment?

Patients with:

frequent, recurrent episodes
severe episodes (psychosis, severe impairment, suicidality)
chronic episodes
presence of co-morbid psychiatric or other medical conditions
presence of residual symptoms
difficult-to-treat episodes

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What are the risk factors for chronic or recurrent depressive episodes?

Earlier age of onset
Greater number of previous episodes
Severity of the initial episode (defined by the presence of a greater number of symptoms, suicidal ideation, or psychomotor agitation)
Disruptions of the sleep-wake cycle
Presence of comorbid psychopathology (particularly persistent depressive disorder/dysthymia)
Family history of psychiatric illness
Presence of negative cognitions
High neuroticism
Poor social support
Stressful life events

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Indications for ECT

acute SI (I)
psychotic features (I)
treatment-resistant depression (I)
medication intolerance (III)
catatonic features (III)
prior response to ECT (III)
rapidly deteriorating physical health (III)
pregnancy for any of the above (III)
patient preference (IV)

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What are the first-line medication treatments for panic disorder?

(all the SSRIs and venlafaxine)
escitalopram, citalopram, fluoxetine, sertraline, paroxetine, fluvoxamine

Recall: CBT»pharmacoptherapy BUT CBT+pharmacotherapy is superior to either alone

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What are the second-line medication treatments for panic disorder?

Study These Flashcards

Clomipramine + imipramine
alprazolam, clonazepam, diazepam, lorazepam
mirtazapine
reboxetine

What are the second-line adjuncts for panic disorder?

Study These Flashcards

2nd line: alprazolam, clonazepam

What medications are explicitly NOT recommended in panic disorder?

buspirone trazodone propranolol tiagabine

What are the first-line medications for SAD?

escitalopram, sertraline, paroxetine, fluvoxamine (NO citalopram or fluoxetine) venlafaxine pregabalin Recall: CBT is considered first line for SAD and in most cases CBT is as effective as CBT+pharmacotherapy

What are the second-line medications for SAD?

citalopram alprazolam, bromazepam, clonazepam gabapentin phenelzine

What are the adjuncts for SAD?

aripiprazole, risperidone paroxetine buspirone

What are the first-line medications for GAD?

escitalopram, paroxetine, sertraline duloxetine, venlafaxine pregabalin agomelatine Recall: CBT = pharmacotherapy, combination only recommended if one alone fails

What are the second-line medications for GAD?

``` alprazolam, bromazepam, diazepam, lorazepam vortioxetine bupropion buspirone quetiapine hydroxyzine ```

What are the adjuncts for GAD?

pregabalin

What are the first-line treatments for BPAD I depression?

``` quetiapine (I) lithium (II) lamotrigine (II) lurasidone (II) lamotrigine + any (II) lurasidone + li/val (I) ```

What are the second-line treatments for BPAD I depression?

``` cariprazine (I) valproic acid (II) adj SSRI/bupropion (I) olanzapine + fluoxetine (II) ECT (IV) ```

What are the first-line treatments for BPAD mania?

``` lithium epival asenapine +/- li/val aripiprazole +/- li/val risperidone +/- li/val quetiapine +/- li/val paliperidone cariprazine ``` * all level I evidence except asenapine and aripiprazole combos (level II)

What are the second-line treatments for BPAD mania?

``` lithium + epival olanzapine +/- li/val haldol ziprasidone carbamazepine ECT ```

What are the first-line treatments for BPAD I maintenance?

``` lithium (I) epival (I) lamotrigine (I) quetiapine (I) quetiapine + li/val (I) aripirazole +/- li/val (II) asenapine (II) ```

What are the second-line treatments for BPAD I maintenance?

``` olanzapine (I) risperidone LAI (I) risperidone LAI adj. (II) lurasidone + li/val (III) ziprasidone + li/val (II) carbamazepine (II) paliperidone (II) ```

What are the first-line treatments for BPAD II depression?

quetiapine (I)

What are the second-line treatments for BPAD II depression?

``` lithium (II) lamotrigine (II) venlafaxine (II) sertraline (II) bupropion adj (II) ECT (III) ```

What are the first-line treatments for BPAD II maintenance?

quetiapine (I) lithium (II) lamotrigine (II)

What are the second-line treatments for BPAD II maintenance?

venlafaxine (II)

CANMAT recommends lithium for BPAD when:

``` classic grandiose mania few prior episodes mania -> depression -> euthymia course family history of BPAD family history of lithium response ```

CANMAT recommends valproic acid for BPAD when:

dysphoric mania, predominant irritable/dysphoric mood multiple prior episodes comorbid substance abuse history of head trauma

CANMAT recommendation for mixed-feature treatment:

atypical antipsychotics +/- divalproex, combination typically required. specifically asenapine, aripiprazole, olanzapine and ziprasidone

CANMAT recommendation for BPAD w/ anxious distress:

quetiapine olanzapine with lithium or fluoxetine lurasidone with lithium

CANMAT recommendation for BPAD rapid cycling:

``` lithium divalproex olanzapine quetiapine NOT lamotrigine ```

Which mood stabilizers affect OCP levels?

carbamazepine lamotrigine topiramate

What is the effect of lamotrigine and OCP?

they reduce the efficacy of each other (CANMAT pg 131)

Preferred choice of meds in BPAD for breastfeeding as per CANMAT:

olanzapine | quetiapine

Risk factors for BPAD in pediatric depression:

``` family history (+) early age of onset (+) psychotic symptoms (+) ``` cyclothymia emotional/behavioural dysregulation subthreshold manic symptoms atypical depression

First-line treatments for mania in children:

``` First line: lithium (I) risperidone (I) - consider with ADHD quetiapine (II) aripirazole (II) asenapine (II) ```

Second-line treatments for mania in children:

``` olanzapine (II) lurasidone (II) quetiapine adj (III) ```

First-line treatments for BPAD depression in children:

lurasidone (II)

Second-line treatments for BPAD depression in children:

lamotrigine (IV) | lithium (IV)

First-line treatments for BPAD maintenance in children:

lithium epival aripirazole

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