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  • Image not available. Extensive treatment guidelines are available to assist in the treatment of major depressive disorder, including medication management. Clinicians treating individuals with major depressive disorder should be familiar with these guidelines.
  • Image not available. When evaluating a patient for the presence of depression, it is essential to rule out medical causes of depression and drug-induced depression.
  • Image not available. The goal of pharmacologic treatment of depression is the resolution of current symptoms (i.e., remission) and the prevention of further episodes of depression (i.e., relapse or recurrence).
  • Image not available. When counseling patients with depression who are receiving antidepressant medications, the patient should be informed that adverse effects might occur immediately, while resolution of symptoms may take 2 to 4 weeks or longer. Adherence to the treatment plan is essential to a successful outcome, and tools to help increase medication adherence should be discussed with each patient.
  • Image not available. Antidepressants are generally considered equally efficacious in groups of patients with major depressive disorder. Therefore, other factors, such as age, side effect profile, and past history of response, are used to guide the selection of antidepressants.
  • Image not available. When determining if a patient has been nonresponsive to a particular pharmacotherapeutic intervention, it must be determined whether the patient has received an adequate dose for an adequate duration and whether the patient has been medication adherent.
  • Image not available. Pharmacogenetic tests (e.g., the FDA-approved AmpliChip to evaluate CYP2D6 and CYP2C19 polymorphisms) are now commercially available. However, there are no standard or well-accepted recommendations for the use of pharmacogenetic testing as it relates to antidepressant treatment of major depressive disorder.
  • Image not available. When evaluating response to an antidepressant, in addition to target signs and symptoms, the clinician must consider quality-of-life issues, such as role, social, and occupational functioning. In addition, the tolerability of the agent should be assessed because the occurrence of side effects may lead to medication nonadherence, especially given the chronicity of the disease and need for long-term medication management.

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  1. Explain the pathophysiologic mechanisms impacting the CNS proposed to underlie major depressive disorder.

  2. List the major symptoms exhibited in a patient suffering from major depressive disorder as defined in the DSM-IV-TR.

  3. Recommend appropriate duration of antidepressant therapy based on the treatment phase and patient history.

  4. List factors that would guide selection of a specific antidepressant for an individual patient.

  5. Compare and contrast the pharmacology and side effect profile of individual antidepressants.

  6. Provide recommendations on proposed differences in antidepressant efficacy that may be relevant for some patients.

  7. Apply pharmacokinetic and pharmacodynamic principles to guide medication management decisions.

  8. Recommend specific exercise parameters to augment antidepressant response.

  9. Recommend pharmacotherapy in a patient exhibiting a partial response following an adequate dose and duration of medication.

  10. Describe the general approach to treatment for special populations (e.g., elderly, pediatric, and pregnant patients).

  11. Identify treatment options for patients who are treatment resistant.

  12. Monitor for adverse events or severe toxicity that may be associated with a particular medication regimen.

  13. Differentiate treatment combinations that are contraindicated from those that can be used with caution and careful monitoring.

  14. Recommend treatment options for major depressive ...

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