Treatment for Depression
49 flashcards · Other · by Andrew Watters
What is the annual/lifetime prevalence of major depressive episode?
annual: 4.7% lifetime: 11.3%
What is the annual/lifetime prevalence of major depressive disorder?
annual: 3.9% lifetime: 9.9%
What is the average time course for a major depressive episode?
50% are less than 3 months
What are some common physician rating scales for depression?
HAM-D
What are some common patient rating scales for depression?
PHQ-9 QIDS-SR
What are the phases of depression treatment?
Acute: 8-12 weeks Maintenance: 6 - 12 months
What are the 1st line psychotherapies for acute MDD?
CBT IPT BA
What are the 1st line psychotherapies for maintenance MDD?
CBT MBCT
What is the evidence regarding combined psychotherapy and medications?
meds + CBT is better than either alone
What are the 1st line SUPERIOR EFFICACY medications for depression?
sertraline escitalopram venlafaxine XR mirtazapine citalopram agomelatine
What are additional first-line medications for depression (other than superior efficacy)?
buproprion desvenlafaxine (Pristiq) duloxetine (Cymbalta) fluoxetine (Prozac) fluvoxamine (Luvox) milnacipran (Ixel) paroxetine vortioxetine (Trintillex)
What are 2nd line medications for depression?
amitriptyline, chlomipramine (TCAs) levomilnacipran (Fetzima) - SNRI moclobemide (reversible MAO-A inhibitor) quetiapine selegiline (irreversible MAO-B inhibitor) trazodone vilazodone
What medication has level 1 evidence for depression with cognitive dsyfunction?
vortioxetine
What medication has level 1 evidence for depression with sleep deprivation?
agomelatine
What medication has level 1 evidence for depression with somatic symptoms?
duloxetine bupropion
What are first-line adjuvant medications for depression?
aripiprazole quetiapine risperidone
What are second-line adjuvant medications for depression?
brexpiprazole (Level 1) bupropion lithium mirtazapine modafinil olanzapine (Level 1) triiodothryronine
What factors may promote switching antidepressants over using an adjuvant for depression?
1st medication No response Poor tolerance (side effects) Less severe (more time) Pt preference
What factors may promote using an adjuvant over switching antidepressants for depression?
2+ medication trials Well-tolerated Partial response Specific residual symptoms to target Severe episode (less time) Pt preference
What defines "early improvement" in treatment for depression?
>20-30% reduction in sx from baseline in 2-4 weeks
What is the recommendation for medication adjustments in pts with no early-improvement?
Increase dose if medication is tolerated Else switch
What does rTMS stand for?
repetitive Transcranial Magnetic Stimulation
What does tDCS stand for?
transcranial Direct Currect Stimulation
What is the evidence for rTMS in the treatment of acute depression?
First line (Level 1) for pts with minimum 1 failed antidepressant, else 2nd line
What is the evidence for rTMS in the treatment of maintenance depression?
Level 3
What is the evidence for ECT in the treatment of acute depression?
Generally second line, first line for some situations (Level 1)
How does rTMS compare to ECT?
rTMS is less effective than ECT; patients who have failed ECT are unlikely to benefit from rTMS
What factors promote ECT to first line treatment?
(Level 1) acute SI psychotic features treatment-resistant depression (Level 3) medication intolerance catatonic features deteriorating physical condition previous favorable response pregnancy
What medications are recommended post-ECT for maintenance?
untried antidepressant nortriptyline + lithium venlafaxine + lithium
What are the benefits of using medications for maintenance post-ECT?
reduces relapse by approx 50%
How effective is ECT?
One of the most effective treatments for MDD 70-80% response rate 40-50% remission
What are the common side effects of ECT?
general anaesthesia headache muscle soreness nausea manic/mixed switch
What is the death rate for ECT?
1 in 74,000
What are the common cognitive side effects with ECT?
transient disorientation anterograde + retrograde amnesia (usually transient)
What is the seizure risk for rTMS (vs. spontaneous risk in general population)?
0.1-0.6% (0.07-0.09%)
What does treatment schedule look like with rTMS?
daily (5 days/week), maybe 3x/week 20-30 sessions
What are the side effects of rTMS?
scalp pain during stimulation headache post stimulation
What are common alternative/complimentary treatments for depression?
lightbox therapy sleep deprivation exercise therapy yoga accupuncture natural health products
What is the evidence for lightbox therapy for depression?
1st-line mono for seasonal depression (Level 1) 2nd-line mono/adjuvant for mild-moderate depression (Level 2)
What is the evidence for sleep deprivation therapy for depression?
3rd-line adjuvant for mod-severe depression (Level 2)
What is the evidence for exercise therapy for depression?
1st-line mono for mild-moderate depression (Level 1) 2nd-line adjuvant for mod-severe depression (Level 1)
What is the evidence for yoga as treatment for depression?
2nd-line adjuvant for mild-mod depression (Level 2)
What is the evidence of accupuncture for depression?
3rd-line adjuvant for mild-mod depression (Level 2)
What is the prescription for lightbox therapy for depression?
30 mins, early morning for 6 months 10,000 Lux
What are common side effects of lightbox therapy?
eye strain headache nausea agitation sedation
What is the prescription for exercise therapy for depression?
30 min moderate intensity 3x/week, 9 weeks
What is the evidence for Saint John's Wort in treating depression?
mild-mod depression = 1st line mono (level 1) mod-severe depression = 2nd line adjuvant (level 2)
What is the evidence for omega-3s in treating depression?
mild-mod depression = 2nd line mono or adjuvant (Level 1) mod-severe depression = 2nd line adjuvant (Level 2)
What is the evidence for SAM-e in treating depression?
mild-moderate depression = 2nd line adjuvant (Level 1) mod-severe depression = 2nd line adjuvant (Level 2)