Skip to Main Content

KEY CONCEPTS

KEY CONCEPTS

  • imageMultiple guidelines are available to guide the treatment of major depressive disorder (MDD), including medication management. Clinicians treating individuals with MDD should be familiar with key tenets of these guidelines.

  • imageOther potential causes of symptoms such as medical conditions, medications, and other substances must first be ruled out when evaluating a patient for a diagnosis of MDD.

  • imageThe goals of treatment for MDD are the resolution of current symptoms (ie, remission) and the prevention of further episodes of depression (ie, relapse or recurrence).

  • imageWhen counseling patients with MDD who are receiving traditional antidepressant medications, the patient should be informed that transient adverse medication reactions might occur initially, while the symptoms of depression may take 2 to 4 weeks to improve and up to 3 months for full resolution. Adherence to the treatment plan is essential for a successful outcome, and tools to help increase medication adherence should be discussed with each patient.

  • imageSince available antidepressants are considered equally efficacious for MDD, factors such as comorbid medical conditions, age, adverse effect profile, and past history of response are used to guide medication selection.

  • imageWhen determining if a particular medication is ineffective for a patient, it is essential to evaluate the dose and duration of treatment as well as patient adherence to the medication.

  • imageNovel antidepressants that target GABA and glutamate systems may have a more rapid and transient effect on symptoms. They are typically used in conjunction with traditional antidepressants for refractory symptoms.

  • imagePharmacogenetic tests are now commercially available. Resources are available to guide their use when clinicians are presented with testing results as it relates to antidepressant treatment of MDD.

  • imageWhen evaluating antidepressant response, the clinician must consider quality-of-life issues, such as social, and occupational functioning in addition to target signs and symptoms. The tolerability of the agent should also be assessed due to the occurrence of adverse medication reactions that may lead to medication nonadherence. This is especially important in cases of recurrent episodes and long-term medication management.

PATIENT CARE PROCESS

Patient Care Process for Major Depressive Disorder

image

Collect

  • Patient characteristics (eg, age, sex, gender identity, race, pregnancy status)

  • Current and past medical/psychiatric history (including information on first-degree family members)

  • Past medication history, including medications not tolerated and any medication allergies (also collect on first-degree family members)

  • Social history (eg, tobacco, ethanol, and other substance use as well as social supports and/or stressors)

  • Current medications including over-the-counter (OTC), herbal products, dietary supplements, and medical or recreational cannabis use

  • Objective data

    • Blood pressure, heart rate, weight

    • Labs including thyroid function tests, serum creatinine, complete blood count (CBC), liver function tests, urine toxicology screen, blood alcohol level, medication serum concentrations, and pharmacogenomics testing if available

    • Reported symptoms of depression or other rating scale assessment (eg, Patient Health Questionnaire 9 [PHQ-9], Beck Depression inventory [BDI]) (Tables 88-1 and 88-2 and Chapter e81, “Evaluation of Psychiatric Illness”)

Assess

  • Suicidality (eg, Columbia-Suicide ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.