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  • Depression is a common and chronic disease that can cause serious harm to patients and increases the risk of death.

  • Treatment goals for depression include acutely reducing symptoms, helping the patient return to a full level of functioning, and preventing a future episode or relapse.

  • Medications commonly used to treat depression include selective serotonin reuptake inhibitors (eg, sertraline), serotonin-norepinephrine reuptake inhibitors (eg, venlafaxine), bupropion, and tricyclic antidepressants (eg, amitriptyline).

  • MTM providers should advise care when patients switch between antidepressants to avoid withdrawal symptoms and ensure a consistent therapeutic response.

  • Patients with depression should be assessed for suicide risk, and MTM providers should be familiar with supportive resources for patients expressing suicidal ideation.


Recognizing Depression

Diagnostic criteria for a major depressive episode include the presence of 5 or more of the following symptoms on a daily basis during a 2-week period: 1) depressed mood; 2) diminished pleasure in all or most activities; 3) significant weight loss or gain; 4) changes in sleep pattern; 5) psychomotor agitation (ie, restlessness) or retardation (ie, lethargy); 6) fatigue; 7) feelings of worthlessness or guilt; 8) poor concentration or decision making; or 9) recurrent thoughts of death or suicide. In a patient experiencing depression, these symptoms are generally moderate to severe, impair daily functioning, and cannot be attributed to another medical condition, a substance (eg, medication-induced), or bereavement.1,2

Evidence demonstrates that depression is a common and chronic disease that can cause serious harm to patients and increases the risk of death. Table 20-1 shows typical signs and symptoms of depression. These symptoms, especially physical symptoms, often cause patients to seek medical help from their physicians. Some of the more concerning symptoms are feelings of guilt or worthlessness because these occur more frequently in patients considering suicide.3

Table 20-1.Signs and Symptoms of Depression4

Secondary Causes of Depression

Before a patient is diagnosed with depression, other contributing factors should be ruled out. These may include medications the patient is currently taking or other medical conditions known to cause depression. For example, many patients with neurological disorders experience symptoms similar to depression; these conditions will likely affect how these patients are treated for depression.1, 2 Whenever possible, a suspected causative drug or disease should be addressed before or simultaneously with the treatment of depressive symptoms to ensure optimal response. Table 20-2 shows ...

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