Depression.txt

Card Set Information

Author:
dohertys
ID:
163358
Filename:
Depression.txt
Updated:
2012-07-21 00:54:04
Tags:
depression guidelines
Folders:

Description:
depression guidelines
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user dohertys on FreezingBlue Flashcards. What would you like to do?


  1. Depression
  2. DDx - Organic Causes for Depression
    • hypothyroidism
    • chronic fatigue syndrome
    • fibromyalgia
    • anemia
  3. Screening for organic causes in Depression
    • History and physical
    • CBC
    • TSH
    • Other tests if suggestive
  4. DDx Mental Illnesses
    • Bereavement
    • Adjustment disorders
    • Bipolar disorder
    • Anxiety disorder
    • Personality disorder (especially Cluster B)
  5. Quick screening questions for Depression:
    • In the past month, have you lost interest or pleasure in things you usually like to do?
    • Have you felt sad, low, down, depressed or hopeless?
  6. Diagnostic Criteria for Depression
    • A) 5+ of depression Sx
    • B) not a mixed or manic episode
    • C) significant distress or impairment
    • D) not 2ยบ to substance abuse or general medical condition
    • E) not better accounted for by bereavement
  7. A criteria for depression
    • 5+ of following during same 2 week period with change from prior fxn.
    • At least 1 of 5 is depressed mood or loss of interest/pleasure.
    • 1) depressed mood (most of day, nearly every day)
    • 2) loss of interest or pleasure in all, or almost all actives
    • 3) significant weight loss (> 5% in month) or change in appetite nearly every day
    • 4) insomnia or hypersomnia
    • 5) psychomotor agitation or retardation (observed by others)
    • 6) fatigue or loss of energy
    • 7) worthlessness or excessive guilt
    • 8) diminished ability to think or concentrate
    • 9) recurrent thoughts of death, recurrent suicidal ideation
  8. How to screen for MDE in past?
    • Any times where felt depressed in past enough that:
    • missed work or school
    • lost weight
    • tried to kill themselves or was suicidal
  9. How to differ between bereavement and MDE?
    • MDE can be differentiated from bereavement by:
    • severity of Sx (psychosis or suicidal)
    • anhedonia (total loss of pleasure)
    • duration of impairment (longer than 2 months)
  10. First choice treatment for depression?
    • Antidepressants are 1st choice for depression, especially moderate or severe
    • 1st line antidepressants - SSRIs, buproprion, mirtazepine, venlafaxine
  11. Choosing an anti-depressant
    Based on efficacy, tolerability and anxiety indications
  12. Antidepressants with evidence for superior efficacy
    • escitalopram (Cipralex)
    • sertraline (Zoloft)
    • venlafaxine-XR (Effexor)
    • Possibly duloxetine (Cymbalta), buproprion-SR (Wellbutrin), mirtazepine (Remeron)
  13. Antidepressants with evidence for superior tolerability
    • citalopram (Celexa)
    • escitalopram (Cipralex)
    • sertaline (Zoloft)
    • meclobemide (Manerix)
  14. Antidepressants with evidence in anxiety disorders
    • (based on Canadian Guidelines)
    • escitalopram (Cipralex)
    • paroxetine (Paxil)
    • sertraline (Zoloft)
    • venlafaxine-XR (Effexor)
  15. Name the SSRI's
    • Citalopram
    • Escitalopram
    • Fluoxetine
    • Fluvoxamine
    • paroxetine
    • sertraline
  16. SNRI
    • desvenlafaxine
    • duloxetine
    • venlafaxine-XR
  17. Novel action
    buproprion-SR, mirtazepine, trazodone
  18. What is a RIMA
    • reversible monoamine oxidase inhibitor
    • Moblobemide
  19. 2nd line antidepressants
    TCA's (amitriptyline, clomipramine, desipramine, imipramine, nortriptyline)
  20. 3rd line antidepressants
    • MAOI's
    • Phenezline
    • Tranylcypromine
  21. How long should patients be on an antidepressant?
    • MDE - at least 4-6 months
    • MDE with risk factors (chronic, recurrent, severe or difficult to treat depression) at least 2 years
    • Recurrent 2+ MDE - lifelong
  22. If no response to initial antidepressant therapy
    • Reassess diagnosis, consider psychotherapy
    • Optimizine antidepressant - increase to maximum tolerable dose
  23. If you have optimized antidepressant and no response:
    • Switch antidepressants - no difference between within or between classes
    • Augment with an augmenting agent
    • Add augmenting agent to current
    • Add 2nd anti-depressant in different class to current
  24. What are the augmenting agents?
    • Triiodothyronine 25-50 micrograms per day
    • OR
    • Lithium 600-900mg/d or to serum level of 0.6-1 mM
    • or
    • atypical antipsychotic (olanzepine, risperidone, quetiapine)
  25. Typical doses of antipsychotics in augmentation
    • Olanzepine 2.5-10mg/d
    • Risperidone 0.5 - 3 mg/d
    • Quetiapine 100-300 mg/d
  26. What is the augmentation dose of olanzepine?
    Olanzepine 2.5 - 10 mg/d
  27. What is the augmentation dose of risperidone?
    Risperidone 0.5 - 3 mg/d
  28. What is the augmentation dose of quetiapine?
    Quetiapine 100-300mg/d
  29. OSCE appraoch to depression?
    • ID
    • RFA
    • Stressors, Symptoms, Coping, Substances, Safety
    • Screen for psychosis, mania, anxiety, abuse, suicidality
    • PPsychHx - diagnoses, meeds, hospitalizations
    • FHx of depression, suicide, schizo
    • PMHx
    • Phsyical exam
    • Labs - TSH, CBC

What would you like to do?

Home > Flashcards > Print Preview