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Questions and Answers
What is the recommended duration of antidepressant treatment before considering a patient treatment-resistant?
Which of the following is NOT a recommendation for partial responders after 6 to 8 weeks of treatment?
Which monitoring parameter is essential for evaluating therapeutic outcomes after discontinuing antidepressants?
For patients on serotonin-norepinephrine reuptake inhibitors, what vital sign should be monitored regularly?
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What should be done prior to starting TCA therapy in children and patients over 40 years of age?
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Which of the following symptoms should be monitored for after the initiation of any antidepressant?
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Which strategy is NOT mentioned as an option for those with no response to antidepressants?
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What is an important method to measure the nature and severity of depressive symptoms during evaluation?
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What adverse consequence could arise from using higher doses of antidepressants?
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Regular monitoring after discontinuation of antidepressants should occur for how long?
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Study Notes
Session Objectives
- Understand the etiology and pathophysiology of Major Depressive Disorder (MDD).
- Recognize clinical presentation of MDD including emotional, physical, and cognitive symptoms.
- Establish treatment goals for MDD patients.
- Recommend appropriate pharmacotherapy strategies for MDD.
- Create a monitoring plan for treatment efficacy and side effects.
Introduction to Major Depressive Disorder
- Clinical depression significantly impacts mind and body, affecting daily activities such as eating, sleeping, working, and self-perception.
- Major depression is marked by intense sadness, despair, mental slowing, concentration loss, pessimism, lack of pleasure, self-depreciation, and variable hostility.
Types of Depression
- Dysthymic Disorder: Chronic low-grade depression lasting over two years, characterized by hopelessness, fatigue, poor self-esteem, sleep and appetite variations, and impaired decision-making.
Clinical Presentation and Diagnosis
- Emotional Symptoms: Include diminished pleasure, loss of interest, anxiety, guilt, and psychotic features (e.g., hallucinations).
- Physical Symptoms: Changes in appetite and weight (commonly decreased), fatigue, loss of sexual interest, and unexplained physical issues (headaches, stomach pain).
- Sleep Patterns: Issues include early morning awakening, insomnia, and oversleeping.
- Cognitive Symptoms: Decreased concentration, poor memory, confusion, and indecisiveness.
Diagnostic Criteria for MDD
- Clinical symptoms that align with depression.
- Duration of symptoms must be sufficient for diagnosis.
- Assessment of quality of life impact.
- Consideration of selective serotonin reuptake inhibitors (SSRIs).
Pharmacotherapy Options
- SSRIs: Effective first-line treatments for MDD; examples include fluvoxamine and sertraline, with specific dosing guidelines.
- Serotonin Syndrome: A serious condition arising from increased serotonin activity, presenting as agitation, sweating, fever, and coordination issues.
Side Effects of SSRIs
- Gastrointestinal: Nausea, vomiting, diarrhea (notable for fluoxetine/sertraline); constipation for paroxetine.
- Central Nervous System: Insomnia (fluoxetine), drowsiness (paroxetine), headaches, and dry mouth.
- Sexual Dysfunction: Common across all SSRIs, with fluoxetine causing minimal effects.
Tricyclic Antidepressants (TCAs)
- Block re-uptake of norepinephrine (NE) and serotonin (5-HT); include amitriptyline, imipramine, and doxepin.
- Commonly used for anxiety, chronic pain, and migraine relief.
- Notable side effects: dry mouth, dizziness, drowsiness, constipation, and confusion.
Treatment-Resistant Depression
- Adequate treatment duration of 4-8 weeks is essential before evaluating effectiveness.
- For partial responders, consider dose adjustment, augmentation, or adding psychotherapy.
- Nonresponders may require switching to another antidepressant or adding therapies like psychotherapy or electroconvulsive therapy (ECT).
Monitoring Therapeutic Outcomes
- Key parameters include plasma concentrations, adverse effects, remission of symptoms, and social/occupational functioning.
- Regular monitoring post-discontinuation of antidepressants recommended for several months.
- Blood pressure monitoring and ECG assessments are advised for patients on serotonin-norepinephrine reuptake inhibitors (SNRIs) and TCAs, particularly in certain populations.
- Vigilantly assess for suicidal ideation during initial treatment phases.
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Description
This quiz explores the pharmacotherapy options for Major Depressive Disorder (MDD). It covers the etiology, clinical presentation, treatment goals, and monitoring plans for effective treatment. Test your understanding of the key concepts in the management of MDD.
