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Content Update

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.

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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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For the chapter in the Wells Handbook, please go to Chapter 68. Major Depressive Disorder.

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KEY CONCEPTS

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KEY CONCEPTS

  • 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 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).

  • 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 for 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 (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.

  • 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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A diagnosis of major depressive disorder (MDD) is given when an individual experiences one or more major depressive episodes without a history of a manic or hypomanic episode. A ...

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