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FMGE depression important questions DSM-5 antidepressants ECT 2024

I now have comprehensive data from the medical library. Let me compile the complete FMGE-oriented notes on Depression.

🧠 DEPRESSION - Complete FMGE Topper's Notes

1. CLASSIFICATION OF DEPRESSIVE DISORDERS (DSM-5)

Disorder	Key Feature
Major Depressive Disorder (MDD)	≥1 major depressive episode
Persistent Depressive Disorder (Dysthymia)	Chronic low-grade depression ≥2 years (≥1 yr in children)
Disruptive Mood Dysregulation Disorder	Childhood disorder; severe recurrent temper outbursts
Premenstrual Dysphoric Disorder (PMDD)	Mood symptoms in the week before menses
Substance/Medication-Induced Depressive Disorder	Due to drugs/substances
Depressive Disorder Due to Another Medical Condition	Hypothyroidism, stroke, cancer, etc.
Other Specified / Unspecified Depressive Disorder	Subthreshold presentations

FMGE tip: Dysthymia is now called "Persistent Depressive Disorder" in DSM-5. ICD-10 still uses "Dysthymia."

2. DSM-5 CRITERIA FOR MAJOR DEPRESSIVE EPISODE

Mnemonic: SIG E CAPS (or DEPWAS+FC)

At least 5 of 9 symptoms for ≥2 weeks, causing significant distress/impairment. At least ONE symptom must be (1) or (2):

#	Symptom	Mnemonic
1	Depressed mood most of the day, nearly every day	S - Sleep
2	Anhedonia - markedly diminished interest/pleasure	I - Interest (lost)
3	Significant weight/appetite change (>5% body weight in 1 month)	G - Guilt
4	Sleep disturbance - insomnia or hypersomnia	E - Energy (low)
5	Psychomotor agitation or retardation	C - Concentration
6	Fatigue or loss of energy	A - Appetite
7	Feelings of worthlessness or excessive/inappropriate guilt	P - Psychomotor
8	Impaired concentration or indecisiveness	S - Suicidal ideation
9	Recurrent thoughts of death, suicidal ideation, or plan

Critical rules:

Minimum 2 weeks duration
Must NOT be due to substance, medication, or another medical condition
Must NOT have any prior manic/hypomanic episode (which would make it Bipolar Disorder)
Must cause significant distress OR impaired functioning

FMGE high-yield: "5 out of 9, at least 2 weeks, at least one is depressed mood or anhedonia."

3. ICD-10 CRITERIA (IMPORTANT FOR FMGE)

ICD-10 uses a different framework - Depressive Episode with:

Core symptoms (at least 2 of 3):

Depressed mood
Loss of interest/anhedonia
Decreased energy/increased fatiguability

Additional symptoms:

Reduced concentration
Reduced self-esteem/self-confidence
Ideas of guilt/worthlessness
Pessimistic views of the future
Sleep disturbance
Decreased appetite
Suicidal ideation/acts
Reduced libido
Morning worsening of mood

Severity (ICD-10):

Severity	Criteria
Mild	2 core + 2 additional (total ≥4), function maintained with some difficulty
Moderate	2 core + 3-4 additional, function considerably difficult
Severe without psychosis	3 core + ≥4 additional, marked distress
Severe with psychosis	As above + hallucinations/delusions

4. PATHOPHYSIOLOGY / NEUROBIOLOGY

Monoamine Hypothesis (Classic)

Depression = deficiency of serotonin (5-HT), norepinephrine (NE), and/or dopamine (DA) in cortical/limbic areas
Evidence: Reserpine (depletes monoamines) causes depression; MAOIs and TCAs raise monoamines and treat depression
Limitation: Monoamine levels rise immediately but clinical improvement takes 2-4 weeks

Neurotransmitter Receptor Hypothesis

Low monoamines → compensatory upregulation of postsynaptic receptors
Postmortem studies show increased serotonin-2 receptors in frontal cortex of suicide victims

Neuroplasticity / Neurotrophic Hypothesis

Stress → decreased BDNF (Brain-Derived Neurotrophic Factor)
Chronic stress → hippocampal atrophy and neuronal loss
Antidepressants restore BDNF and promote neurogenesis

HPA Axis Dysregulation

Hypercortisolemia in depression
Dexamethasone Suppression Test (DST): Non-suppression seen in melancholic depression (cortisol NOT suppressed after 1 mg dexamethasone overnight)
DST is NOT used as a diagnostic test clinically but asked in FMGE

Key Brain Areas

Amygdala: Hyperactive - processes negative emotions
Prefrontal cortex: Hypoactive - impaired executive function
Hippocampus: Atrophied - memory impairment
Anterior cingulate cortex: Abnormal - mood regulation disrupted

5. EPIDEMIOLOGY

Lifetime prevalence: ~15-17% (higher in women)
Female:Male ratio = 2:1
Mean age of onset: ~29 years (but can occur at any age)
Most common psychiatric disorder in women
Most common cause of disability worldwide (WHO)
Higher rates with: low socioeconomic status, loss of spouse, chronic illness, social isolation
Suicide risk: 15% of severely depressed patients die by suicide

6. SUBTYPES / SPECIFIERS (HIGH-YIELD FOR FMGE)

Melancholic Features

Severe anhedonia (complete inability to feel pleasure)
Early morning awakening (terminal insomnia)
Mood worse in the morning (diurnal variation)
Psychomotor disturbance (agitation or retardation)
Significant anorexia/weight loss
Excessive/inappropriate guilt
Also called "endogenous depression" - arises without clear external stressor
Responds better to TCAs, ECT

Atypical Features

Mood REACTIVITY (brightens in response to positive events - key distinguishing feature)
Increased appetite/weight (hyperphagia)
Hypersomnia (increased sleep)
Leaden paralysis (heavy feeling in limbs)
Rejection sensitivity (lasting social impairment)
Younger age of onset
More common in Bipolar II
Responds better to MAOIs > SSRIs

FMGE classic: Atypical depression = mood reactivity + reverse neurovegetative symptoms (overeating, oversleeping)

Psychotic Depression

Presence of hallucinations or delusions during depressive episode
Mood-congruent (themes of guilt, worthlessness, death) - more common
Mood-incongruent (unrelated themes) - may suggest schizoaffective disorder
Treatment: Antidepressant + antipsychotic, or ECT (preferred)

Seasonal Pattern (Seasonal Affective Disorder - SAD)

Regular temporal relationship between episodes and a particular season
Typically Winter depression (less light exposure)
Full remission in spring/summer
Reverse neurovegetative symptoms (hypersomnia, hyperphagia, carbohydrate craving)
Treatment: Light therapy (phototherapy) is first-line

FMGE tip: SAD - bright light therapy >2500 lux, administered in the morning

Peripartum Onset

Episode begins during pregnancy OR within 4 weeks of delivery (DSM-5)
ICD-10 uses "Postpartum" (within 6 weeks)
Distinct from baby blues (resolves within 2 weeks)
Associated with psychosis (postpartum psychosis) - medical emergency

Catatonic Features

Stupor, mutism, negativism, posturing, echolalia, echopraxia
Can occur in depression or schizophrenia
Treatment: Benzodiazepines (first-line), then ECT

7. PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA)

Depressed mood for most of the day, more days than not, for ≥2 years (≥1 year in children/adolescents)
During the 2 years: no symptom-free period >2 months
≥2 of: poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, hopelessness
No manic/hypomanic episodes
"Double Depression" = Dysthymia + superimposed MDD (poor prognosis)
Children: irritable mood can substitute for depressed mood; duration criterion = 1 year

8. DEPRESSION IN SPECIAL POPULATIONS

Children/Adolescents

Somatic complaints, psychomotor agitation, mood-congruent hallucinations predominate in children
Anhedonia, hopelessness, psychomotor retardation more common in adolescents
Adolescents: antisocial behavior, substance use, truancy, school failure
Irritability may replace sad mood
Childhood depression is the most severe form and runs in families

Elderly

More somatic complaints (pain, GI disturbance, fatigue, hypochondriasis)
Pseudodementia (cognitive impairment from depression mimicking dementia)
Often underdiagnosed because symptoms attributed to "normal aging"
Correlates with: low SES, loss of spouse, chronic illness, social isolation
First-line: SSRIs (safest in elderly)

Postpartum Depression

Within 4 weeks (DSM-5) / 6 weeks (ICD-10) of delivery
Distinct from Baby Blues (benign, peaks day 3-5, resolves by 2 weeks)
Postpartum Psychosis: medical emergency, treat with antipsychotic + mood stabilizer

9. DIFFERENTIAL DIAGNOSIS

Condition	Key Feature Distinguishing from MDD
Grief/Bereavement	Episodic sadness, focus on loss (not self-loathing), ability to have moments of pleasure
Bipolar Depression	History of manic/hypomanic episode
Dysthymia	Chronic but less severe; >2 years, fewer symptoms
Adjustment Disorder	Clear stressor, resolves within 6 months of stressor removal
Hypothyroidism	Always check TFTs
Pseudodementia	Cognitive impairment in elderly - responds to antidepressants
Cyclothymia	Milder, chronic (≥2 years) mood cycling; no full MDD or manic episodes

Grief vs. MDD (Classic FMGE Distinction)

Feature	Grief	MDD
Mood	Episodic, wave-like	Persistent, pervasive
Self-attitude	Normal (no self-loathing)	Worthlessness, guilt
Moments of happiness	Preserved	Absent (anhedonia)
Focus	On the lost person	On the self
Duration	Usually resolves in weeks	Persists ≥2 weeks
Suicidal ideation	Passive (want to join deceased)	Active planning

10. ASSESSMENT SCALES (HIGH-YIELD)

Scale	Purpose	Notes
Hamilton Rating Scale for Depression (HAM-D/HDRS)	Assess severity	≤18 = mild-moderate; 19-22 = severe; ≥23 = very severe
PHQ-9	Screening + severity	9-item questionnaire; PHQ-2 is 2-item screen
Beck Depression Inventory (BDI)	Self-rated; 21 items
Montgomery-Asberg Depression Rating Scale (MADRS)	Sensitive to change; used in drug trials
Geriatric Depression Scale (GDS)	For elderly	30-item (or 15-item short form)
Edinburgh Postnatal Depression Scale (EPDS)	Postpartum depression screening
Zung Self-Rating Depression Scale	Self-rated

FMGE tip: Hamilton scale is clinician-rated. BDI/PHQ-9 are self-rated. MADRS is used in drug trials.

11. TREATMENT

A. Antidepressants

SSRIs (First-Line)

Drug	Dose Notes	Special Points
Fluoxetine	Longest half-life (4-6 days); active metabolite norfluoxetine	Safest in pregnancy; least withdrawal symptoms
Sertraline	Most widely used; safe in cardiac patients	Preferred in post-MI depression
Escitalopram	Most selective SSRI; least drug interactions	Very well tolerated
Citalopram	QTc prolongation at high doses
Paroxetine	Short half-life; most anticholinergic SSRI; highest withdrawal risk	Avoid in pregnancy (cardiac defects)
Fluvoxamine	Used primarily for OCD

Onset of action: Clinical improvement in 2-4 weeks (full response in 4-6 weeks) Duration of treatment:

First episode: 6-9 months after remission
Two episodes: 2+ years
Three or more episodes: Lifelong treatment

Common SSRI side effects:

Nausea, diarrhea (most common initially)
Sexual dysfunction (most common long-term)
Insomnia/agitation (especially fluoxetine)
SIADH (hyponatremia - watch in elderly)
Serotonin Syndrome (with MAOIs, tramadol, triptans)

SNRIs

Drug	Notes
Venlafaxine	Also used for GAD, panic; can raise blood pressure at high doses
Duloxetine	Useful for painful physical symptoms, diabetic neuropathy
Desvenlafaxine	Active metabolite of venlafaxine

TCAs (Tricyclic Antidepressants)

Amitriptyline, Imipramine, Clomipramine, Nortriptyline, Desipramine
Mechanism: Block reuptake of NE and 5-HT
Imipramine: First antidepressant discovered; gold standard for enuresis in children
Clomipramine: Most potent serotonin reuptake inhibitor among TCAs; first-line for OCD (among TCAs)
Amitriptyline: Most sedating; useful for chronic pain, migraine prophylaxis
Nortriptyline: Least orthostatic hypotension; preferred in elderly

TCA side effects (3 A's):

Anticholinergic: Dry mouth, constipation, urinary retention, blurred vision, tachycardia
Anti-adrenergic (α1 block): Orthostatic hypotension
Antihistaminic (H1 block): Sedation, weight gain

TCA Toxicity (Overdose):

3 C's: Cardiac (wide QRS, QTc prolongation, arrhythmias), CNS (seizures, coma), Cardiovascular collapse
Most lethal antidepressant in overdose
Treatment: Sodium bicarbonate (for cardiac arrhythmias)
Contraindicated in: Glaucoma (narrow angle), BPH, recent MI, heart block

MAOIs (Monoamine Oxidase Inhibitors)

Phenelzine, Tranylcypromine, Isocarboxazid (irreversible, non-selective)
Selegiline (selective MAO-B inhibitor - used in Parkinson's; transdermal form for depression)
Moclobemide (reversible MAO-A inhibitor - RIMA; safer)

Important MAOI drug interactions:

Tyramine-containing foods (cheese, wine, beer, pickled/fermented foods) → Hypertensive crisis ("cheese reaction")
SSRIs + MAOIs → Serotonin syndrome (DEADLY - washout period required)
- Fluoxetine: 5 weeks washout before starting MAOI (long half-life)
- Other SSRIs: 2 weeks washout
- After stopping MAOI: 2 weeks washout before starting SSRI

Best indication for MAOIs: Atypical depression (MAOIs > SSRIs for this subtype)

Other Antidepressants

Drug	Mechanism	Key Features
Mirtazapine	NaSSA - blocks α2, 5-HT2, 5-HT3, H1	Sedation, weight gain; useful for insomnia/poor appetite; "tetracyclic"
Bupropion	NDRI - NE/DA reuptake inhibitor	No sexual dysfunction; used for smoking cessation; lowers seizure threshold - avoid in eating disorders, seizures
Trazodone	5-HT2 antagonist + weak SERT inhibitor	Highly sedating; used for insomnia; priapism (rare)
Vortioxetine	Serotonin modulator (5-HT1A agonist + SERT inhibitor)	Procognitive effects; minimal sexual dysfunction
Agomelatine	MT1/MT2 agonist + 5-HT2C antagonist	Restores circadian rhythm; hepatotoxic potential

Lithium

Augmentation in treatment-resistant depression
Antisuicidal effect (reduces suicide by ~80%)
Narrow therapeutic index (0.6-1.2 mEq/L for maintenance)

B. Electroconvulsive Therapy (ECT)

Indications for ECT (HIGH-YIELD):

MDD with severe suicidality (fastest treatment)
MDD with psychotic features
MDD with melancholic features
Treatment-Resistant Depression (TRD) (failed ≥2 adequate antidepressant trials)
Severe catatonia
Depression in pregnancy (safest when medications are contraindicated)
Life-threatening depression (food refusal, severe self-neglect)
Bipolar depression and mania resistant to medications
Postpartum depression (severe)

Absolute Contraindications:

None (only relative contraindications exist)
Relative: Raised intracranial pressure, recent MI, intracranial mass lesion, cerebral aneurysm, recent stroke

ECT Procedure:

Anesthesia: Methohexital (most commonly used barbiturate) or propofol
Muscle relaxant: Succinylcholine (to prevent fractures)
Oxygenation with 100% O2
Bilateral or unilateral (non-dominant hemisphere) electrode placement
Seizure must last 25-60 seconds (optimal)
Bilateral ECT: More effective but more memory side effects
Unilateral (right hemisphere): Less effective but fewer cognitive side effects

Side effects of ECT:

Anterograde amnesia (most common; temporary)
Retrograde amnesia (especially for events close to treatment)
Headache, muscle aches, confusion (postictal)
Cardiovascular: Initial bradycardia (vagal) → tachycardia
No permanent brain damage

Course:

Acute: 6-12 sessions (3/week)
Maintenance ECT: Monthly sessions to prevent relapse

FMGE key: ECT is the FASTEST acting treatment for depression. Best for MDD with psychotic features + melancholic features + suicidality + pregnancy.

C. Transcranial Magnetic Stimulation (TMS/rTMS)

Non-invasive, outpatient
For treatment-resistant depression when ECT not appropriate
No anesthesia required
Side effects: Headache, scalp discomfort; rare risk of seizure
FDA approved

D. Psychotherapy

Type	Notes
Cognitive Behavioral Therapy (CBT)	First-line for mild-moderate depression; targets negative cognitive distortions
Interpersonal Therapy (IPT)	Focuses on grief, role transitions, interpersonal disputes
Behavioral Activation	Increases engagement with rewarding activities
Psychodynamic Therapy	Addresses unconscious conflicts
Mindfulness-Based CBT (MBCT)	For relapse prevention in recurrent depression

For mild depression: Psychotherapy alone may be sufficient
For moderate-severe depression: Combination of antidepressant + psychotherapy is superior to either alone

12. TREATMENT-RESISTANT DEPRESSION (TRD)

Definition: Failure of ≥2 adequate antidepressant trials (adequate dose, adequate duration ≥6-8 weeks)
Strategies:
1. Augmentation: Add lithium, atypical antipsychotic (aripiprazole, quetiapine, olanzapine), thyroid hormone (T3)
2. Combination: Two antidepressants with different mechanisms
3. Switch: To different class (e.g., SSRI → SNRI → MAOI)
4. ECT: Most effective for TRD
5. Ketamine/Esketamine: Rapid-acting (hours); intranasal esketamine (Spravato) FDA-approved for TRD

13. SPECIFIC DRUG-SITUATION PAIRINGS (FMGE FAVOURITE)

Clinical Situation	Drug of Choice
Depression in elderly	SSRI (sertraline, escitalopram)
Depression in pregnancy	Sertraline or fluoxetine (SSRIs generally preferred); ECT if severe
Depression with OCD	Clomipramine (TCA) or SSRIs
Depression with enuresis	Imipramine
Depression with chronic pain	Duloxetine, amitriptyline
Depression with smoking cessation	Bupropion
Depression with insomnia/poor appetite	Mirtazapine
Depression with atypical features	MAOIs (most effective), SSRIs
Depression with melancholic features	TCAs, ECT
Depression with psychotic features	Antidepressant + antipsychotic, or ECT
Depression after MI	Sertraline (safest for cardiac patients)
Depression with sexual dysfunction	Bupropion, mirtazapine (least sexual SE)
Depression + bipolar	Quetiapine, lamotrigine (avoid antidepressants alone)
Treatment-resistant	ECT, ketamine/esketamine, lithium augmentation
Seasonal depression	Light therapy (phototherapy)

14. SEROTONIN SYNDROME vs. NEUROLEPTIC MALIGNANT SYNDROME

Feature	Serotonin Syndrome	NMS
Cause	Serotonergic drugs (SSRIs + MAOIs)	Dopamine blockers (antipsychotics)
Onset	Rapid (hours)	Gradual (24-72 hours)
Tremor/Clonus	Hyperreflexia, clonus (key feature)	Bradyreflexia, "lead pipe" rigidity
Temp	Elevated	Very high (>41°C)
Mental status	Agitation, confusion	Confusion, stupor
Autonomic	Tachycardia, diaphoresis, diarrhea	Tachycardia, diaphoresis
Treatment	Stop serotonergic drugs; Cyproheptadine (5-HT antagonist)	Stop antipsychotic; Dantrolene + Bromocriptine

15. SUICIDE IN DEPRESSION

Risk Factors (HIGH-YIELD Mnemonic: SAD PERSONS)

S - Sex (male complete; female attempt more)
A - Age (elderly men, adolescent girls)
D - Depression
P - Previous attempt (strongest predictor)
E - Ethanol abuse
R - Rational thinking loss
S - Social support lacking
O - Organized plan
N - No spouse
S - Sickness (chronic illness)

Important Facts

15% of severely depressed patients die by suicide
Most common diagnosis in completed suicide: Depression
Most lethal methods: Firearms > hanging > drowning
Lithium has strongest evidence for reducing suicide risk
Previous suicide attempt is single best predictor of future attempt
Clozapine reduces suicide in schizophrenia
Antidepressants: Black box warning - increased suicidal ideation in age <24 years (not adults; monitor closely)

16. BIOLOGICAL TESTS IN DEPRESSION

Test	Finding in Depression
Dexamethasone Suppression Test (DST)	Non-suppression (high cortisol after dexamethasone) - seen in melancholic depression
TRH Stimulation Test	Blunted TSH response
Sleep EEG (PSG)	Shortened REM latency, increased REM density, early morning awakening, decreased slow-wave sleep
Urinary MHPG	Decreased (low NE metabolite)
5-HIAA in CSF	Decreased (low serotonin metabolite - also low in violent suicide)
CRH test	Blunted ACTH response

FMGE classic: Shortened REM latency is the most consistent biological finding in MDD.

17. ANTIDEPRESSANT SIDE EFFECTS SUMMARY TABLE

Side Effect	Drug(s)
Serotonin syndrome	SSRIs + MAOIs
Hypertensive crisis ("cheese reaction")	MAOIs + tyramine foods
Priapism	Trazodone
Seizures	Bupropion (avoid in eating disorders, seizure disorder)
Agranulocytosis	Mirtazapine (rare); Clozapine (not for depression but notable)
Hepatotoxicity	Agomelatine, nefazodone
QTc prolongation	Citalopram, TCAs
Most lethal in overdose	TCAs
Safest in overdose	SSRIs
Sexual dysfunction	SSRIs (most), SNRIs, TCAs
Weight gain	Mirtazapine, paroxetine, TCAs
Discontinuation syndrome	Paroxetine (worst), venlafaxine
SIADH/Hyponatremia	SSRIs (especially in elderly)

18. IMPORTANT MNEMONICS FOR FMGE

SIG E CAPS - 9 symptoms of depression (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal ideation)

"3 A's of TCAs" - Anticholinergic, Anti-adrenergic (alpha block), Antihistaminic

Atypical depression = MHLS - Mood reactivity, Hypersomnia, Leaden paralysis, Sensitivity to rejection

SAD PERSONS - Suicide risk factors

ECT indications - "Suicide + Psychosis + Melancholia + TRD + Pregnancy + Catatonia"

19. KEY NUMBERS TO REMEMBER

Parameter	Value
Duration for MDD diagnosis	2 weeks
Symptoms required for MDD	5 out of 9
Duration for dysthymia (adults)	2 years
Duration for dysthymia (children)	1 year
Duration for adjustment disorder	Resolve within 6 months
Full remission in MDD	0 symptoms for 2 months
Antidepressant onset of action	2-4 weeks
Full antidepressant response	4-6 weeks
Duration of first episode treatment	6-9 months after remission
Lifetime treatment after 3+ episodes	Lifelong
ECT sessions (acute course)	6-12 sessions
ECT frequency	3x/week
Fluoxetine washout before MAOI	5 weeks
Other SSRIs washout before MAOI	2 weeks
MAOI washout before SSRI	2 weeks
HAM-D: very severe	≥23
HAM-D: severe	19-22
Postpartum onset (DSM-5)	Within 4 weeks of delivery
Suicide rate in MDD	~15%
Weight change threshold for MDD	>5% in 1 month

20. FMGE FAVOURITE "TRICK" QUESTIONS

Drug of choice for atypical depression? → MAOIs (most effective), SSRIs (first-line in practice)
Most consistent biological finding in MDD? → Shortened REM latency
DST non-suppression is associated with? → Melancholic (endogenous) depression
Antidepressant with most SSRI drug interactions due to long half-life? → Fluoxetine
Which SSRI has maximum risk of discontinuation syndrome? → Paroxetine
TCA safest in elderly? → Nortriptyline (least anticholinergic, least orthostasis)
DOC for postpartum depression (severe)? → ECT (especially if breastfeeding; no medication exposure)
Which antidepressant is used in ADHD? → Bupropion
Which antidepressant causes LEAST sexual dysfunction? → Bupropion, mirtazapine
Fastest acting treatment for depression? → ECT (days vs weeks for medications)
Antidepressant for enuresis? → Imipramine
Anti-suicidal drug in depression? → Lithium
Phototherapy is used in? → Seasonal Affective Disorder (Winter type)
Depression with "reversed" neurovegetative symptoms (hypersomnia, hyperphagia)? → Atypical depression
Irritable mood instead of depressed mood is allowed in which age group? → Children and adolescents

Sources: Kaplan & Sadock's Synopsis of Psychiatry (10th/11th ed.), Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Stahl's Essential Psychopharmacology, Goodman & Gilman's Pharmacological Basis of Therapeutics, Katzung's Basic and Clinical Pharmacology 16e, Maudsley Prescribing Guidelines 15e, Symptom to Diagnosis 4e

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