thera final depression

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coal
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272751
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thera final depression
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2014-05-03 15:00:29
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thera final depression
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  1. emotional symptoms of depression
    • DID A PIG
    • delusional feelings
    • intense sadness
    • deserving of punishment
    • anxiety
    • pessimism about future
    • inability to experience pleasure
    • guilt and worthlessness
  2. physical symptoms of depression
    • G CLAPHS
    • GI complaints
    • chronic fatigue
    • loss of libido
    • appetite disturbances
    • pain
    • heart palpitations
    • sleep disturbances
  3. depressive neurosis
    • chronic disturbance of mood of greater than 2 years
    • involves either depressed mood or loss of interest in most activities
  4. major depressive episode
    presence of 5 or more symptoms during a 2 week period and represents a change from previous functioning

    • at least 1 symptom is
    •   depressed mood
    •   loss of interest or pleasure
  5. DSM - IV diagnostic criteria
    symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  6. common drug therapy associated w/ depression
    • IROD CHIMPS
    • isotretinoin
    • reserpine
    • oral contraceptives
    • diuretics
    • clonidine
    • hydralazine
    • interferon
    • methyldopa
    • propranolol
    • steroids
  7. phases of depression
    duration and goal
    • acute 6-10 wks, goal remission
    • continuation 4-9 mo, prevent relapse
    • maintenance 12-36 mo, prevent recurrence
  8. CI to electroconvulsive therapy
    • increased intracranial pressure
    • cerebral lesions of brain
    • recent MI
    • recent intracranial hemorrhage
    • large aneurysms
  9. MAOI
    • phenelzine
    • tranylcypromine
    • selegiline
  10. common side effects of MAOIs
    • orthostatic HoTN
    • weight gain
    • sexual dysfunction
  11. MAOI that causes sedation
    phenelzine
  12. MAOI that causes stimulation
    tranylcypromine
  13. mixed NE/DA reuptake inhibitors
    • buproprion - wellbutrin
    • 150,    300-450
  14. CI of mixed NE/DA reuptake inhibitors
    • seizure disorders
    • eating disorders
  15. AE of mixed NE/DA reuptake inhibitors
    • anorexia
    • seizures
    • insomnia/restlessness
  16. TCAs
    • amitriptyline - elavil
    • 25,  100-300
  17. TCAs AE
    • cardiovascular effects
    • wt gain
    • anticholinergic
  18. SNRIs
    • venlafaxine - Effexor 37.5,   75-375
    • desvenlafaxine - pristiq 50, 50-400
    • duloxetine - Cymbalta 60, 60-120
  19. SNRIs AE
    • N/V/D
    • anorexia
    • nervousness
    • dry mouth
  20. venlafaxine - Effexor AE
    elevations in BP
  21. duloxetine - Cymbalta AE
    hepatotoxicity
  22. mixed 5HT/NE
    • mirtazapine - remeron
    • 15,  15-45
  23. mirtazapine - remeron AE
    • weight gain
    • somnolence
    • constipation
    • dry mouth
  24. mirtazapine - remeron others
    • CrCl < 10 redue dose by 50%
    • decreased clearance with hepatic impairment
    • decreased concentration with carbamazepine
  25. SSRIs
    • escitalopram - Lexapro 10, 10-20
    • citalopram - celexa 20, 20-40
    • fluoxetine - Prozac 10-20, 10-80
    • paroxetine - paxil 20, 20-60
    • sertraline - Zoloft 50, 100-200
  26. patients who are good candidates for SSRIs
    • seizures
    • elderly
  27. SSRI AE of HA
    citalopram - celexa
  28. SSRI AE of wt gain
    paroxetine - paxil
  29. SSRI AE of anorexia, wt loss
    fluoxetine - prozac
  30. SSRI AE of sexual dysfunction
    sertraline - zoloft
  31. SSRIs AE of insomnia/restlessness
    fluoxetine - prozac
  32. SSRI AE of sedation/fatigue
    paroxetine - paxil
  33. SSRIs serious adverse effects
    • QT prolongation
    • bleeding risk
    •   concomitant w/ASA, NSAIDS, warfarin
    • SIADH and hyponatremia
    • serotonin syndrome
  34. SPARI
    viibryd - vilazodone
  35. mixed 5HT
    • trazodone - desyrel  150,  150-600
    • nefazodone - serzone
  36. time frame for onset of antidepressants
    4-6 weeks
  37. drugs FDA approved for augmentation therapy
    • aripiprizole - abilify
    • quetiapine - seroquel
  38. FDA approved medical food for adjunctive treatment of depression
    L-Methylfolate - deplin
  39. who receives lifelong maintenance therapy
    • pts < 40 yo with 2 or more prior episodes
    • pt of any age with three or more prior episodes
  40. depression in pregnancy
    sertraline (Zoloft) and fluoxetine (Prozac) most safety evidence

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