1 / 14

Treating Depression in the Primary Care Setting

Treating Depression in the Primary Care Setting . Pharmacologic Interventions. Presented by: Jonathan Betlinski, MD. Date: 09/25/2014. Disclosures and Learning Objectives. Learning Objectives Describe the Acute, Continuation and Maintenance phases of MDD treatment

pearl
Download Presentation

Treating Depression in the Primary Care Setting

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Treating Depressionin the Primary Care Setting Pharmacologic Interventions Presented by: Jonathan Betlinski, MD Date: 09/25/2014

  2. Disclosures and Learning Objectives • Learning Objectives • Describe the Acute, Continuation and Maintenance phases of MDD treatment • Know 3 ways to augment antidepressants • Know 5 ways to address non-response Disclosures: Dr. Jonathan Betlinski has nothing to disclose.

  3. Depression in the Primary Care Setting • Quick review of Screening for Depression • Quick review of Nonpharmacology • Pharmacological Treatment of Depression • Acute Phase • Continuation Phase • Nonresponse • Maintenance Phase • Next Week's Topic

  4. SIG E CAPS for Depression S sleep decreased (or increased) I interest decreased G guilt or worthlessness E energy decreased C concentration difficulties A appetite disturbance or weight loss P psychomotor agitation or retardation S suicidal thoughts and depressed mood!

  5. Treatment of Depression in Primary Care Start all treatment with a medical work up http://www.nimh.nih.gov/health/publications/depression/index.shtml#pub6 Next comes Sleep Hygiene www.cci.health.wa.gov.au/docs/Info-sleep%20hygiene.pdf And Exercise http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/pdf/nihms-386053.pdf And Behavioral Activation www.personal.kent.edu/~dfresco/CBT_Readings/BM_Lejuez_BATD_Manual.pdf Antidepressants are no better than placebo for mild to moderate depression http://medicine.plosjournals.org/archive/1549-1676/5/2/pdf/10.1371_journal.pmed.0050045-L.pdf

  6. Pharmacology – Acute Phase Choose antidepressant based on Prior response (individual or family) Patient preference Side effect profile Safety in overdose Availability and costs Drug-Drug interactions Impacts on co-morbid conditions https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

  7. Pharmacology – Acute Phase – Initial Most AD's are comparably effective SSRI: citalopram, sertraline, fluoxetine, escitalopram SNRI: venlafaxine, duloxetine, desvenlafaxine, Mirtazapine (sedation, weight gain) Bupropion (weight loss, nicotine cravings) http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

  8. Pharmacology – Acute Phase – Next Titrate to an effective dose Goal is a PHQ-9 of less than 5 Response may take 4-8 weeks If side effects are too much, try lowering the dose or switching. Save MAOIs and TCAs for second line http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

  9. Pharmacology – Nonresponse Reappraise diagnosis Assess side effects Assess comorbid conditions Review psychosocial factors Check treatment adherence Check on psychotherapy progress Consider medication switch vs. augment http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

  10. Pharmacology – Nonresponse - Changing Switch to another AD from same class Switch to an AD from a different class Try an SNRI when SSRI not effective Augment with a different class AD Augment with T3 Augment with lithium Augment with a second-generation antipsychotic http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

  11. Pharmacology – Continuation Phase Continue Acute Phase treatment For 4-9 months Monitor regularly for recurrence Use depression-focused psychotherapy to help prevent relapse (CBT)

  12. Pharmacology – Maintenance Phase Continue full therapeutic dose Continue antidepressants indefinitely For a complicated 2nd episode For a third episode For chronic depression http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 Monitor with PHQ-9 or WHO-DAS http://www.who.int/entity/classifications/icf/WHODAS2.0_36itemsSELF.pdf?ua=1

  13. Treating Depression in Primary Care Depression is both common and treatable PHQ-9 simplifies detecting and quantifying depression--and monitoring, too The first steps in the treatment of recovery are usually nonpharmacological Appropriate medications can be helpful Treat to remission

  14. The End! Next Week's Topic: Assessing Suicide Risk

More Related