April 28, 2018
Use of Ketamine for Improving Suicidal Ideation: Ketamine is an emerging agent for the rapid treatment of depression. None of the other available antidepressants are effective for rapid relief of suicidal thoughts in patients with depression. Results from a randomized clinical trial suggest that adjunctive use of ketamine was more effective than midazolam in reducing clinically significant suicidal ideation.
September 16, 2017
Antidepressant Switching vs Augmentation on Remission Among Major Depressive Disorder Patients: Many patients with major depressive disorder (MDD) do not achieve remission with their first course of antidepressant pharmacotherapy, and some may benefit from an alternative treatment. A clinical trial compared the effectiveness and adverse effect profiles of three alternative treatment strategies: 1) switching to bupropion sustained-release monotherapy; 2) augment current treatment with bupropion sustained-release; or 3) augment current treatment with aripiprazole. Augmentation with aripiprazole resulted in a slight but statistically significant increased likelihood of remission during 12 weeks of treatment compared to switching to bupropion monotherapy. Further study is needed to evaluate the long-term risk-benefit ratio of this treatment strategy.
CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
For the chapter in the Wells Handbook, please go to Chapter 68. Major Depressive Disorder.
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.
When evaluating a patient for the presence of depression, it is essential to rule out medical causes of depression and drug-induced depression.
The goals of treatment for depression are the resolution of current symptoms (ie, remission) and the prevention of further episodes of depression (ie, relapse or recurrence).
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 for a successful outcome, and tools to help increase medication adherence should be discussed with each patient.
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.
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.
Pharmacogenetic tests (eg, 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.
When evaluating response to an antidepressant, in addition to target signs and symptoms, the clinician must consider quality-of-life issues, such as ...