Depressive disorders and antidepressants

Patient Health Questionnaire-9 (PHQ-9) is used for rating the severity of which disorder?

Depression

Which antidepressant can be used for chronic musculoskeletal pain (e.g., back pain)?

Duloxetine (Cymbalta)

What is a treatment option that is as effective as antidepressants to treat mild-to-moderate depression?

Psychotherapy

What are symptoms for major depression (AKA major depressive disorder)? How long must someone have depressive symptoms to have a diagnosis of major depression?

D or A SIG E CAPS

Depressive mood or anhedonia (loss of interest or pleasure), sleep (insomnia or hypersomnia), interest (loss of; including libido), guilt or worthlessness, energy (loss), concentration (loss), appetite (>5% body weight changes/30d), psychomotor retardation/agitation, suicidal ideation → 5 or more signs and symptoms for 2 weeks

What is considered an adequate trial of Zoloft (sertraline) for the treatment of depression?

4-6 weeks with therapeutic doses of 50-200 mg/day

What are the contraindications of bupropion (Wellbutrin)?

Seizure disorder, eating disorder, withdrawal from alcohol or BZDs, concurrent use of Zyban

Trazodone is an antidepressant commonly prescribed for what disorder?

Insomnia

Patient has been doing well for 3 years on Cymbalta (duloxetine) 60 mg/day for depression. He had relapse of depressive symptoms with no changes with his medication regimen. List 2 factors that can cause the worsening of his symptoms.

1. Increased stress or situational depression

2. Smoking (leads to lower drug concentrations)

When adding SSRIs (e.g., Prozac, Paxil, Luvox) to the medication regimen for patients with polypharmacy, what needs to be considered?

If there are other serotonergic agents → risk of serotonin syndrome, and DDIs → Prozac, Paxil and Luvox are CYP inhibitors that may increase concentrations of other drugs

Tricyclic antidepressants are not used for depression anymore due to high ADRs
(e.g., high anticholinergic side effects). Low doses are used for what off-label uses?

Chronic pain such as neuropathic pain, insomnia

SSRIs have a higher risk of sexual side effects. What antidepressant has the least risk?

Bupropion (Wellbutrin), mirtazapine (Remeron)

How long does it take to see the optimal response to antidepressants for the treatment of depression? Explain why there is a delayed onset of action.

4-6 weeks because you need time to increase the BDNF levels that helps with neurogensis

Auvelity is a combination of 2 meds (_______________ & _______________)

Dextromethorphan and Bupropion

Compare the onset of action for Auvelity vs other antidepressants (SSRIs, SNRIs).

Onset of action for Auvelity is faster compared to other antidepressants since it contains dextromethorphan

What classes of antidepressants can increase blood pressure?

SNRIs

What is the oral antidepressant that has most studies for breast feeding mothers with minimal secretion via breast milk?

Sertaline (Zoloft)

What are Trade names for the 2 FDA-approved medications for postpartum depression?

Zurzuvae (Zuranolone) and Zulresso (Brexanolone)

Which antidepressants are prescribed off-label for insomnia?

Low dose Trazodone (Desyrel) and mirtazapine (Remeron)

Which 2 antidepressants should not PO QHS due to side effect of insomnia.

1. Fluoxetine (Prozac)

2. Bupropion (Wellbutrin)

Which antidepressant has higher risk of N/V as a 5HT-3 agonist?

Sertraline (Zoloft)

Which antidepressant is an antiemetic as a 5HT-3 antagonist which is useful for depressed patients on chemotherapy with high N/V.

Mirtazapine (Remeron)

What antidepressant have increased absorption when taken with food (should be included as a counseling point for patients)?

Vilazodone (Viibryd)

The FDA-approved treatments fluoxetine (Sarafem), sertraline (Zoloft), and paroxetine (Paxil) for premenstrual dysphoric disorder are in the antidepressant class of

SSRI antidepressants

What is esketamine (Spravato) FDA-approved for treatment-resistant depression and depression with acute suicidal ideation and behavior. This is a controlled substance administered via what route (PO, IN, IM, IV infusion)?

Nasal spray (IN)

St. John’s wort is an OTC antidepressant that is a potent enzyme _______ (inducer or inhibitor). What are the potential PK and PD drug interactions for a patient on Lipitor and Viibryd?

CYP3A4, inducer