Chapter Five
Summary
Depression is the most common complaint presented by mental health patients, and it is very important for
the professional to determine the exact nature and probable cause affecting the patient. Obtaining this information is
crucial in formulating the treatment plan including the appropriate psychotropic medications.
The professional should be aware of other medical conditions known to cause or worsen a patient’s
depression. These include conditions like cancer, arthritis, diabetes, and HIV disease. It may be necessary to suggest
a thorough history and physical to all patients presenting with depression.
All mental health professionals should also be aware that many other medications can cause depression.
These include medications for hypertension, some pain medications, anti–Parkinson drugs, anti-anxiety drugs, drugs
of abuse, and various cold remedies.
Specific Discussion Questions:
1. Explain the various exogenous and endogenous factors involved in the etiology of clinical depression?
2. Why is it so important to rule–out physical causes of one’s depression.
3. How do other medications play a role in the cause of depression?
4. How effective is psychotherapy alone in treating some forms of depression?
5. How do the newer antidepressants compare to the older medications in terms of effectiveness and side effect
profiles?
6. Explain the nature of the anti-cholinergic side effects associated with tricyclics.
7. Explain how MAOIs work differently than other antidepressant medications.
8. What dietary restrictions are there with MAOIs?
9. Which non-pharmaceutics have been found to be effective?
10. What other medications could be added to “boost” an antidepressant?
Possible True/False Questions:
1. Exogenous factors refer to environmental stress and other “outside” influence in the cause of depression.
2. Endogenous factors refer to causes from “within” or biological causes.
3. SSRIs primarily affect the neurotransmitter serotonin.
4. The tricyclic antidepressants have the least amount of side effects.
5. Typically speaking medications like amitriptyline and doxepin are more sedating than protriptyline or
dopamine.
6. While trazodone affects serotonin like other SSRI medications, it has a different action on the serotonin
receptor sites.
7. Tricylics are safer than SSRIs for the suicidal patient.
8. Lexapro and Pristiq are newer antidepressants.
9. Serotonin syndrome includes fever, muscle rigidity, and hypotension.
10. Typically MAOIs are sedating medications.
Multiple Choice Questions:
1. Which of the following deseases/disorders has been known to cause or worsen depression?
a. Alheimer’s
b. Congestive heart failure
c. Fibromyalgia
d. All of the above
2. Which of the following types of drugs has been known to cause or worsen depression?
a. Anti-inflammatory drugs like: Indocin, Vioxx, or Celebrex.
b. Blood thiners like: Cumidin or Heprin
c. Sleep aides like: Ambien, Sonata or Halcion.
d. both A and C above.
3. What percentage of patients with depression also have suicidal ideation?
a. Seventy percent
b. Eighty percent
c. Ninety percent
d. none of the above
4. Psychotherapy alone is a powerful tool in reducing depression. Patients typically show the greatest gains in
the first:
a. 5 sessions
b. 10 sessions
c. 16 sessions
d. 28 sessions
5. The anticholinergic side effects are more common with which type of antidepressants?
a. tricyclics
b. SSRIs
c. MAOIs
d. none of these
6. Which of the following drugs has been shown to affect norepinephrine levels?
a. maprotiline
b. citalopram
c. paroxetine
d. desipramine
7. Sweating, yawing and inhibited orgasm are common side effects with:
a. MAOIs
b. SSRIs
c. tricyclics
d. heterocyclics
8. Which of the following SSRIs is associated with more sedation?
a. Prozac
b. Lexapro
c. Celexa
d. Paxil
9. Dietary restrictions such as avoiding foods containing tyramine are associated with which class of
antidepressants?
a. MAOIs
b. SSRIs
c. Unicyclics
d. none of these.
10. Which of the following is not an MAOI?
a. Marplan
b. Nardil
c. Parnate
d. Aplenzin
11. According to Sinacola and Peters–Strickland, which of the following “holistic/herbal” remedies shows the
greatest efficacy in reducing depression?
a. St. John’s Wort
b. SAM-e
c. Ginkgo Biloba
d. DHEA
12. You are working with a patient who has responded well to antidepressants in the past, and has had only a
moderate response to SSRIs. Aside from increasing the dose, you might also suggest:
a. Adding an MAOI
b. Adding another SSRI
c. Trying a lithium boost
d. Adding a benzo
13. You have started working with a new patient who presents with severe depression, low energy and
motivation. She is also 40 pounds overweight. Her primary care physician would like to know if you know of
any medication possibilities. You might consider all of the medications below except:
a. Celexa
b. Wellbutrin
c. Remeron
d. Lexapro
14. You are treating another patient with depression, but after taking a thorough history, you learn that she has
had an eating disorder and a seizure disorder in the past. Which medication would not be a good choice?
a. Welbutrin
b. Effexor
c. Zoloft
d. None of these
15. Which of the following are not typically used for depressed/pain management patients?
a. Elavil
b. Neurontin
c. Pristiq
d. Luvox
16. You are working with a patient with OCD. Which of the following medications is not considered an anti–
obsessive?
a. Prozac
b. Anafranil
c. Wellbutrin
d. Luvox
17. “Serotonin syndrome” includes all of the following symptoms except:
a. hypertension
b. fever
c. muscle rigidity
d. agitation
18. Exercise is an excellent idea for depressed patients as it increases levels of:
a. ECT
b. THC
c. substance P
d. PEA
19. As a rule, all antidepressants take about ____ days to begin working.
a. 3 days
b. 6 days
c. 8 days
d. 14 days
20. A typical daily dose of Prozac or Paxil is:
a. 2-4 mg.
b. 20-40 mg.
c. 75-100 mg.
d. 200-300 mg.
Alternative Class Assignments and Essay Questions
1. If one were treating a patient with treatment resistant depression and the client had tried all sorts of
medications on a mono-therapy basis, what types of medication combinations could be considered?
2. If your patient is responding well to an SSRI, but sexual dysfunction is a concern, what other medications
could be added or substituted?
3. Which patients should consider ECT or TMS?
4. Make an argument for or against using medication in patients with Dysthymia.
5. Have your students make a chart/table of all of the antidepressants. Be sure to include typical doses, side
effects and information about which neurotransmitters are targeted.
6. Explain why Pristiq may be a better choice than Effexor for a patient with liver compromise.
7. What is the main deference between Pexeva and Paxil.
Read the Case Vignette in this chapter and answer the following questions:
Case Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in the case?
2. Is there another disorder that may apply or should be ruled-out?
3. Do you agree with the medication suggestions made in this case?
4. Any other medications that might be considered…what is the rationale?
5. If you were asked to follow-up on this case as the treating therapist, would you offer any additional
suggestions or approaches?
Chapter Five
Answer Key
True/False Questions:
Multiple Choice Questions: