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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 pharmacological 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 effects, and past history of response, are used to guide the selection of medication management.
  • 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. 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.

Upon completion of the chapter, the reader will be able to:

  • 1. Explain the pathophysiologic mechanisms underlying major depressive disorder.
  • 2. List the major symptoms exhibited in a patient suffering from major depression as defined in the DSM-IV-TR.
  • 3. Recommend an appropriate duration of antidepressant therapy based upon the treatment phase and recent patient history.
  • 4. Define response, remission, recurrence, and relapse.
  • 5. List the factors that would guide selection of a specific antidepressant for an individual patient.
  • 6. Compare and contrast the pharmacology and side-effect profile of individual antidepressants.
  • 7. Differentiate the pharmacokinetic parameters for the various antidepressants.
  • 8. Apply pharmacokinetic principles to guide medication treatment decisions.
  • 9. Assess the usefulness of plasma concentrations for each antidepressant.
  • 10. List the cytochrome P450 inhibitory potential for the newer generation antidepressants.
  • 11. Identify pharmacokinetic and pharmacodynamicdrug interactions given the patient’s current drug regimen.
  • 12. Recommend pharmacotherapy in a patient exhibiting a partial response after an adequate dose and duration of medication.
  • 13. Describe the general approach to treatment for special populations (i.e.g., elderly, pediatric, and pregnant patients).
  • 14. Identify treatment options for patients who are treatment- resistant.
  • 15. Define the role of the pharmacist in the screening, recognition, and treatment of depression when a collaborative approach is utilized.

A diagnosis of major depressive ...

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