Therapeutics - Depression 3

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Therapeutics - Depression 3
2015-02-23 11:37:34
Therapeutics Depression

Therapeutics - Depression
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  1. Neurotransmitters, 5-HT, DA and NE, are increased or decreased in depression?
  2. What are the theories of depression?
    • biogenic amine hypothesis
    • 5-HT/NE link hypothesis
    • postsynaptic alteration theory
    • disruption of Brain Derived Neuropathic Factor expression in the hippocampus
  3. Approximately 45% to 60% of patients with major depression have what biological marker:
    • Neuroendocrine abnormality
    • Including: hypersecretion of cortisol or a lack of cortisol suppression
    • Inability of the brain to suppress the hypothalamic–pituitary–adrenal (HPA) axis
  4. All depressed patients should have what diagnostics performed?
    • Complete physical examination
    • Mental status examination
    • Basic laboratory workup, with CBC w/ differential, thyroid function tests, and electrolytes
  5. What drugs are associated with Depression?
    • Acne treatment: Isotretinoin
    • Anticonvulsants: Levetiracetam, Topiramate, Vigabatrin, Antimigraine agents, Triptans
    • Cardiovascular medications:β-Blocker, Clonidine, Methyldopa, Reserpine
    • Hormonal therapy: Gonadotropin-releasing hormone, Oral contraceptives, Steroids (e.g., prednisone), Tamoxifen
    • Immunologic agents: Interferons, Smoking cessation drugs, Varenicline
  6. What are the major physical symptoms of depression?
    • Fatigue
    • Pain (like HA)
    • Sleep and appetite disturbances
    • Loss of Libido
    • Slowed movements
  7. What are the mnemonics for the diagnosis of depression?
    • SIGECAPS: Sleep, Interest, Guilt, Energy loss, concentration, appetite, psychomotor agitation, suicidal thoughts
    • SAD FACES: Sleep, appetite, depressed, fatigue, agitation, concentration, esteem, suicidal thoughts
  8. Should anti-depressives be withheld in children/Adolescents with suicidal ideation?
    No, withholding may increase the risk
  9. What anti-depressives provide protection against suicide in adults and elderly?
    Fluoxetine and Venlafaxine
  10. What anti-depressives were found to not increase suicidality in young people?
    Fluoxetine and Venlafaxine
  11. If the depressive episode is mild to moderate in severity, what is the first line agent?
  12. What are the advantages of SSRIs?
    • Increased safety in overdose
    • Improved tolerability