Depression, PTSD, And Anxiety Disorders

Women are more likely to develop PTSD compared to men. This could be due to various factors such as the higher prevalence of traumatic events experienced by women, including sexual assault and domestic violence. Women may also have different physiological responses to trauma and may be more likely to experience symptoms of anxiety and depression, which are often associated with PTSD. Additionally, societal factors such as gender roles and expectations may contribute to women being more vulnerable to developing PTSD.

MAO inhibitors (MAOis) are a type of medication used to treat depression and other mental health conditions. One of the side effects of MAOis is hypertensive crisis, which is a sudden and severe increase in blood pressure. This side effect can be exacerbated by certain foods that contain tyramine, such as aged cheeses, cured meats, and fermented foods. When tyramine is consumed, it can cause the release of norepinephrine, leading to a dangerous spike in blood pressure. Therefore, it is important for individuals taking MAOis to avoid tyramine-rich foods to prevent hypertensive crisis.

Women more commonly diagnosed than men

Diazepam is rapidly distributedly, has rapid onset, and rapid termination (due to distribution in fat) making good for “fast on fast off”. Lorazepam may be used for a longer effect, but has a slower onset.

Citalopram (Celexa®) comes with a warning for prolonged QT interval. The QT interval is a measure of the electrical activity of the heart, and a prolonged QT interval can increase the risk of a life-threatening irregular heartbeat. This warning is important for healthcare professionals and patients to be aware of, as it may influence the decision to prescribe or take citalopram.

All SSRIs, which stands for selective serotonin reuptake inhibitors, have been found to be effective in treating panic disorder. This class of medications works by increasing the levels of serotonin in the brain, which helps regulate mood and reduce anxiety symptoms. Numerous studies have demonstrated the efficacy of SSRIs in reducing the frequency and severity of panic attacks, as well as improving overall functioning and quality of life for individuals with panic disorder. Therefore, it can be concluded that all SSRIs are indeed effective for the treatment of panic disorder.

Venlafaxine XR (Effexor XR) is the only SNRI approved for panic disorder

CBT - 13-20 weeks of weekly sessions + daily homework, Pharm- 8-12 weeks including 4-6 weeks at max. tolerable dose

Flumazenil is a BZD antagonist

While more effective than SSRI in (only) first 2 weeks, BZD are second line due to abuse potential

Withdrawal symptoms may manifest in 1-2 days for short acting agents and 5-10 days for long acting agents

Depressive Symptoms are not symptoms of PTSD

BZDs are not primarily excreted unchanged through urine. They undergo extensive metabolism in the liver, forming active metabolites that are then excreted through urine. This is why the answer stating that BZDs are excreted unchanged, primarily through urine, is false.

Requires daily administration

Elderly patients have a decreased fat to lean tissue ratio, which can result in increased sensitivity to the CNS effects of benzodiazepines. Temazepam is metabolized via phase II metabolism, which is not affected by age-related changes in CYP metabolism. Therefore, it is a preferred choice in geriatric patients due to decreased CYP metabolism with advanced age. The same dose of benzodiazepines may not be used in elderly patients as they are more sensitive to the CNS effects, so monitoring and dose adjustment are necessary.

CBT alone should be used except in cases where the risks of untreated OCD outweigh the risks of drug use

Flumazenil is competitive antagonist

Benzodiazepines are considered second line treatment for patients who cannot tolerate antidepressants in the management of anxiety. This means that benzodiazepines are not the first choice of treatment for anxiety, but they may be used if other options such as antidepressants are not suitable for the patient. On the other hand, benzodiazepines are considered first line treatment for patients requiring rapid relief of anxiety. This means that if a patient needs immediate relief from their anxiety symptoms, benzodiazepines may be the initial treatment of choice.

Long-acting benzodiazepines are associated with no significant rebound insomnia because their effects last longer and they are gradually eliminated from the body. On the other hand, short-acting benzodiazepines are associated with moderate rebound insomnia because they are quickly metabolized and eliminated from the body, leading to a sudden withdrawal of the drug's effects, which can result in rebound insomnia.

In Children/Adolescent patients with OCD, CBT + SSRI treatment is recommended. FDA-approved SSRI for this include Fluoxetine, Fluvoxamine, Sertraline, Clomipramine

While both Venlafaxine ER and IR have been shown to be effective, IR does not carry the FDA indication

Act on serotonin receptors.
Neither structurally nor mechanistically related to BZD
Slower onset of effects (weeks) compared to BZD (days)
Require multiple dosing

12 weeks to assess a full response, but additional responses may be noted for up to 6 months

The recommended taper for BZD therapy is to decrease the dosage by 50% over a period of 2-3 weeks. This gradual reduction in dosage helps to minimize withdrawal symptoms and allows the body to adjust to the lower levels of the medication. It is important to taper off BZD therapy slowly and under the guidance of a healthcare professional to ensure a safe and successful discontinuation of the medication.

CBT is first in the treatment algorithm of treatment for PTSD

Chlordiazepoxide, Clonazepam, Diazepam, and Flurazepam are long-acting benzodiazepines. These medications have a longer duration of action in the body compared to short-acting benzodiazepines like Alprazolam, Lorazepam, Oxazepam, and Temazepam. Triazolam is an intermediate-acting benzodiazepine, which means it has a shorter duration of action compared to long-acting benzodiazepines.

All SSRIs are hepatically metabolized and should therefore be used cautiously in patients with hepatic impairment. Renally, doses of fluoxetine and fluvoxamine should be lowered in addition to the initial dose of paroxetine