Down Again. Major depression is a devastating illness that. Strategies for Treating Refractory Depression. In this article: Find out more on page 42

Size: px
Start display at page:

Download "Down Again. Major depression is a devastating illness that. Strategies for Treating Refractory Depression. In this article: Find out more on page 42"

Transcription

1 Focus on CME at the University of Université Manitoba Laval Down Again Strategies for Treating Refractory Depression By Guylain Bouchard, MD, MSc; and Nicole Thibodeau, MD, FRCPC Major depression is a devastating illness that affects a considerable number of people. Lifetime prevalence of depression in the general population is 17%. According to the National Comorbidity Survey, the prevalence of unipolar depression between the ages of 15 and 54 is 21.3% in women and 12.7% in men. 1 Major depression is not only a common condition, but also a recurring one. Results in a general outpatient context are striking, with 87% of patients experiencing a recurrence of their depression during the 15-year period the cohort was observed. 2 In a cohort (transverse section) of patients diagnosed with major depression, the condition had been developing for more than two years in approximately one-third of cases. 3 World Health Organization data estimate that major depression was the fourth leading cause of disability in 1990 and it is expected to rank second in In studies where various illnesses were compared with each other, it was discovered that the impact of depression on a person s daily functioning is comparable to that of advanced coronary disease. 4 The cost of physical care (excluding psychiatric care) for people with major depression is two to three times higher than In this article: 1.How serious is depression? 2.What are the neurobiologic concepts in depression today? 3.What are effective treatment strategies for refractory depression? Quick Facts on Depression Depression affects about 121 million people worldwide Depression can be reliably diagnosed and treated in primary care. At any given time, almost 3 million Canadians have serious depression, but less than 1/3 seek help. 20% of patients visiting primary care physicians have depressive symptoms; the condition of nearly half of these may go unrecognized. Find out more on page 42

2 Table 1 Systemic effects of depression Depression seems to not only create damage to the brain, there is a growing fear of it being a systemic disease that may promote: The deposit of fatty tissue Insulin resistance Bone resorption Increase in sympathetic tonus Coagulation Adapted from: Gold PW, Charney DS. Diseases of the mind and brain. Am J Psychiatry. 2002; 159 (11):1826. that of the general population. 1 The suicide rate among people with refractory depression is estimated at 15%. 3 These epidemiological studies convinced us that it would be pertinent to review current studies on depression, particularly when it becomes refractory. What happens neurobiologically? The prevalence of unipolar depression among 15 to 54 year-olds is 21.3% in women and 12.7% in men. The concordance rate between homozygote twins (50% to 55%) versus heterozygote twins (15%) indicates an inherited genetic predisposition to depression. 5 These genetic factors indicate the possible involvement of neurobiologic factors. Historically, the neurobiologic model of depression basically concentrated on a serotonin and norepinephrine deficit. 6 Recently, a more complex hypothesis involving neurotoxic effects related to the activation of the cortisol axis on the hippocampus has been suggested. 7 Depressive symptoms and cognitive problems seem to appear when hippocampal activity and frontal cortex metabolism are disturbed. It seems increasingly clear that serotoninergic and noradrenergic antidepressants slow the excessive activation of the cortisol axis by increasing the efficiency of glucocorticoid receptors in the hypothalamus (primary negative feedback). They also stimulate the activity of the hippocampus (including the induction of neuroprotective factors), which also tends to inhibit the release of corticotrophic releasing factor (CRF) by the hypothalamus. Activation of the cortisol axis, and the vicious circle of neurotoxicity with respect to the hippocampus, are thus reduced (Table 1). 8 All these data point to treatment objectives, such as obtaining a remission (75% improvement in symptoms) or, even better, complete remission. This is important because persistent symptoms of depression are a major predictor of relapse after one year. 9 What is refractory depression? Refractory depression is, unfortunately, a condition often seen by physicians. Following treatment with antidepressants, the chances of obtaining a partial therapeutic response are around 50% to 70%. Remission rates, however, are even lower, approximately 30% to 50% depending on the case series. There are varying definitions of refractory depression, making it difficult to compare studies on treatment efficacy. We have selected the following definition as our guide: Two unsuccessful trials with antidepressants administered at the appropriate dosage level (standard treatment dose) for a sufficiently long period (i.e., six weeks to eight weeks) The Canadian Journal of CME / June 2003

3 Table 2 Factors that encourage optimization The following are factors that encourage optimization: Partial response to the antidepressant, without complete remission. Well-tolerated medication. Adapted from: Well KR, Katon W et al: Am J Psychiatry. 1994; 151: What are the pharmacotherapy strategies? Before discussing these strategies, we should mention the following points: There is no universally recognized consensus. The guidelines are often more conservative than clinical practice. There are few controlled studies. Clinical practice often requires the use of strategies that have not yet been fully validated by controlled studies (particularly with regard to drug combinations). Table 3 Factors that favour substitution The following are factors that favour substitution: Absence of therapeutic response. Partial response, but the presence of unpleasant, persistent side-effects. Adapted from: Fredman SJ, Fava M, Kienke AS, et al: Partial response, non-response, and relapse on SSRIs in major depression: a survey of current next-step practices. J Clin Psychiatry 2000; 61: There are four strategies to consider for your patients with refractory depression. 1. Optimization (increasing the dose) 2. Substitution (changing one medication for another) Following treatment with antidepressants, the chances of a partial therapeutic response are around 50% to 70%.

4 3. Combination (combined use of two antidepressants) 4. Potentiation (adding a non-antidepressant agent to an antidepressant) 1. Optimization This strategy is most commonly used in cases of partial response. For example, increasing fluoxetine from an initial 20 mg/day to a final dose of up to 40 mg/day to 80 mg/day has proved effective in increasing the number of patients who respond. 11 It should be noted that inadequate dosage is probably a common cause of treatment failure, given patients high rate of noncompliance with prescribed treatment (Table 2). 2. Substitution A survey of 400 U.S. psychiatrists has shown that the substitution of a different class of antidepressant is particularly popular in the management of patients with refractory depression (Table 3). Substitution by venlafaxine: Venlafaxine has been the subject of several studies in cases of non-response to a selective serotonin reuptake inhibitor (SSRI). Its efficacy has also been compared to SSRIs in randomized studies. Meta-analyses of these studies show favourable trends for venlafaxine. 12 The comparison of different medications always involves complex considerations, even if they only concern the selection of equivalent doses. Dr. Bouchard is professor, Université Laval, and psychiatrist, mood disorder clinic, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec. Dr. Thibodeau is professor, Université Laval, and director, mood disorder clinic, psychiatry department, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec. Remission rates after treatment with antidepressants are probably around 30% to 50% depending on the case series. Substitution by traditional MAOIs: Monoamineoxidase inhibitors (MAOIs), such as phenelzine and tranylcypromide, are still somewhat difficult to use. They require wash-out periods to eliminate the presence of the previous antidepressant (danger of serotoninergic syndrome, or hypertensive crisis). In addition, they cause orthostatic hypotension on a fairly frequent basis. Remember, however, that MAOIs are very useful agents and are often overlooked in circumstances where more commonly prescribed antidepressants and various combinations have failed. 3. Combinations Combining antidepressants is a strategy that is becoming increasingly popular today. It reflects a common clinical reality in the management of refractory depression, yet convincing data on combining antidepressants remain limited. Combining two SSRIs: This combination is rarely used. It is supported by a number of anecdotal cases. 13 This strategy can be effective when there is a comorbidity of depression and anxiety problems, including obsessive-compulsive problems. Such a combination, however, can increase the risk of serotoninergic sideeffects and syndromes. Combining an SSRI and nefazodone: Anecdotal reports suggest that this combination may be effective. It might even reduce certain SSRI side-effects. 80 The Canadian Journal of CME / June 2003

5 Table 4 Factors that favour potentiation The following are factors that could encourage the use of this strategy: Partial response to the antidepressant. Good tolerance of the antidepressant. There is an interaction with cytochrome P450 2D6 (paroxetine, fluoxetine), however, which may induce the production of a panic-causing metabolite (mcpp). Combining venlafaxine with an SSRI: No studies have been conducted on this combination yet. Only anecdotal reports indicate the combination s possible efficacy. There is, however, the risk of increasing serotoninergic side-effects and the risk of serotoninergic syndrome. 14 We should also remember that venlafaxine is a substrate of cytochrome P450 2D6. Combining mirtazapine with an SSRI: An openlabel study suggests this combination may be effective. 15 The combination of these antidepressants may have the advantage of reducing certain SSRI sideeffects (including sexual dysfunction). On the other hand, the combination also risks increasing sedation and weight gain. Combining bupropion with an SSRI: This combination has been the subject of four open-label studies It may reduce certain SSRI side-effects such as drowsiness. There is a risk of the combination accentuating anxiety or inducing tremor in some patients. Combining venlafaxine and bupropion: A recent open study evaluated this combination, which seemed to be effective. 20 The combination might be useful when symptoms of apathy and hypersomnia are present. The combination may cause a secondary increase in tremor and anxiety. It is a good idea to supervise the patient s blood pressure when using high doses of these medications. Increasing fluoxetine from an initial 20 mg/day to a final dose of up to mg/day is effective.

6 Combining venlafaxine and mirtazapine: This clinical strategy is popular with psychiatrists. It seems to be well tolerated and clinically effective. A study is now underway, but has not yet been published. Combining desipramine (25 mg/day to 75 mg/day) and an SSRI: This combination has been studied the most so far. Several doubleblind studies have been conducted. The combination seems to provide faster action and A meta-analysis of five controlled studies estimates the risk of remaining depressed after adding lithium is 56% to 96% reduced. increased response rates in double-blind studies. 21 Despite the demonstrated benefits, high doses of tricyclics may cause a cardiotoxic effect because of drug interaction (cytochrome P450 2D6). Consequently, followup with blood tests and electrocardiogram is necessary. The decreased elimination of desipramine because of blockage by cytochrome P450 2D6 means treatment has to be initiated using smaller doses, slowly increasing thereafter. 4-Potentiation Table 4 presents the convincing data regarding potentiation. Adding lithium to an antidepressant: Lithium has been used as a potentiator since 1981 and this strategy has been studied extensively since that time. A meta-analysis of five controlled studies estimates that the risk of remaining depressed after the addition of lithium is 56% to 96% reduced. 22 Empirical data do not clearly identify the therapeutic dose and blood levels. Some authors recommend a starting dose of 600 mg/day (if there is no favourable response) to achieve plasma levels of around 0.8 meq/l to 1.0 meq/l. Adverse side-effects when using lithium as a potentiator are generally mild but hypothyroidism or renal failure may occur, hence the need for periodic laboratory testing. Adding thyroid hormones to the antidepressant: This strategy has mainly been studied with respect to tricyclic antidepressant potentiation in euthyroid patients. Triiodothyronine (T 3 ) has proven more effective than thyroxine (T 4 ). A double blind study has shown efficacy comparable to that of lithium. 23 The fact, however, remains that T 3 is rarely used today. The addition of an antipsychotic to an antidepressant: Adding a traditional antipsychotic has long been practised in the management of psychotic depression. Today, potentiation by an atypical antipsychotic is used in patients with major depression, even if no psychotic elements are present. Some symptoms, including severe insomnia, anxiety, severe distress, psychomotor retardation and/or agitation, are reasons for using this strategy. Studies have shown that olanzapine and risperidone enhance dopamine release in the prefrontal cortex. In addition, olanzapine (and risperidone to a lesser degree) increases the release of norepinephrine in the prefrontal cortex. 24 Moderate doses of an antipsychotic are recommended; either risperidone 0.5 mg/day to 2 mg/day, or olanzapine 5 mg/day to 20 mg/day. The addition of an atypical antipsychotic appears promising in the management of refrac- 82 The Canadian Journal of CME / June 2003

7 tory depression. Further studies are awaited in order to have a better idea of the effects of such potentiation. Certain disadvantages (e.g., weight gain, or possible extrapyramidal reactions) mean that this strategy is reserved for particular clinical situations or cases that are treatment-resistant. Dopaminergic agonists: Dopamine seems to play a role in both the development and management of depression. However, the addition of a dopaminergic medication such as pramipexole, 25 amantadine, or pergolide, has not yet been the subject of controlled studies. Psychostimulants: The use of psychostimulants, such as methylphenidate, dextroamphetamine and pemoline, has been evaluated in open-label studies, which seem to indicate that these agents are effective. 26 This strategy would appear to have the advantage of rapid onset. However, it is possible that efficacy wanes over time. In addition, the potentiation may increase anxiety and irritability. Potential abuse by certain vulnerable patients should also be taken into consideration. Modafinil: This medication is used to treat hypersomnia and narcolepsy. It has been identified as a possible adjuvant in the treatment of refractory depression. Its efficacy has been suggested, but there is little proof available at the moment. 27 Anticonvulsants: The addition of anticonvulsants, such as valproic acid, carbamazepine, lamotrigine, gabapentin, and topiramate, may help manage irritability, anxiety and insomnia, but the sole evidence of this is several anecdotal reports. Other potentiators: Potentiators such as inositol, estrogens, opiates, pindolol, and folic acid are mentioned in medical literature, but further studies are required. Buspirone: Buspirone is without doubt one of the molecules whose efficacy is the most controversial in the treatment of refractary depression. The only controlled study that exists reports a response to buspirone of around 51% versus placebo 47%. 28 Take-home message What is refractory depression? Refractory depression is defined as: two unsuccessful trials with antidepressants administered at the appropriate dosage level (standard treatment dose) for a sufficiently long period (i.e., six weeks to eight weeks). What are the strategies? 1. Optimization (increasing the dose) 2. Substitution (changing one medication for another) 3. Combination (combined use of two antidepressants) 4. Potentiation (adding a non-antidepressant agent to an antidepressant) What now? Refractory depression is one of the most serious illnesses of our time. For the clinician, its management represents a major therapeutic challenge. A better knowledge of the treatments available, their efficacy, side-effects and indications is useful. At a time when we are learning more and more about the neurobiological mechanisms involved in depression, and new drugs are becoming available to us, we can increasingly look for remission in our patients. CME Continued on page 86. The Canadian Journal of CME / June

8 References 1. Kessler RC, McGonagle KA, Zhao S, et al: Lifetime and 12- month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51(1): Keller MB, Klerman GL, Lavori PW, et al: Long-term outcome of episodes of major depression. Clinical and public health significance. JAMA 1984; 252(6): Keller MB: Long-term treatment of recurrent chronic depression. J Clin Psychiatry 2001; 62(24): Murray CJL, Lopez AD eds. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability From Diseases, Injuries, and Risk Factors in 1990 and Projected to Cambridge, Mass: Harvard University Press, Kendler KS, Pederson NL, Farahmand BY, et al: The treated incidence of psychotic and affective illness in twins compared with population expectation: a study of Swedish Twin and Psychiatric Registries. Psychol Med 1996; 26(6): Delgado PL, Miller HL, Salomon RM, et al: Tryptophandepletion challenge in depressed patients treated with desipramine or fluoxetine: implication for the role of serotonin in the mechanism of antidepressant action. Biol Psychiatry 1999; 46(2): Sheline YI, Sanghavi M, Mintun MA, et al: Depression duration but not age predicts hippocampal volume loss in medically healthy woman with recurrent major depression. J Neurosci 1999; 19(12): DeBellis MD, Gold PW, Geracioti TD, et al: Association of fluoxetine treatment with reductions in CSF concentrations of corticotropin-releasing hormone and arginine vasopressin in patients with major depression. Am J Psychiatry 1993; 150: Paykel LS: Epidemiology of refractory depression. In: Nolen WA, Zohar J, Roose SP et al. Ed. Refractory Depression: Current Strategies and Future Directions. New York: John Wiley and Sons, 1994, pp Ananth J: Treatment-resistant depression. Psychother Psychosom 1998; 67(2): Fava M, Rosenbaum J, McGrath P, et al. Lithium and tricyclic augmentation of fluoxetine treatment for resistant major depression. Am J Psychiatry 1994; 15(9): Smith D, Dempster C, Glanville J, Freemantle N, Anderson I. Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: A meta-analysis. Br J Psychiatry. 2002; 180: Bondolfi G, Chautems C, Rochat B, et al. Non-response to citalopram in depressive patients : pharmacokinetic and clinical consequences of a fluvoxamine augmentation. Psychopharmacology 1996; 128: John L, Perreault MM, Tao T, et al: Serotonin syndrome associated with nefazodone and paroxetine. Ann Emerg Med 1997; 29(2): Carpenter LL, Yasmin S, Price LH: A double blind, placebo controlled study of mirtazapine augmentation for refractory depression. Presented at the 39th ACNP Annual Congress, San Juan, Puerto Rico, Marshall RD, Randall D, Johannet CM, et al. Bupropion and sertraline combination treatment in refractory depression. J Clin Psychopharmacol 1995; 9: Marshall RD, Liebowitz MR: Paroxetine-bupropion combination treatment for refractory depression. J Clin Psychopharmacol 1996; 16: Bodkin JA, Lasser RA, Wines JD, et al: Combining serotonin reuptake inhibitors and bupropion in partial responders to antidepressant monotherapy. J Clin Psychiatry 1997; 58(4): Spier SA: Use of bupropion with SRIs and venlafaxine. Depress Anxiety 1998; 7(2): Kennedy SH, McCann SM, Masellis M, et al: Combining bupropion SR with venlafaxine, paroxetine, or fluoxetine: a preliminary report of pharmacokinetic, therapeutic, and sexual dysfunction effects. J Clin Psychiatry 2002; 63(3): Seth R, Jennings AL, Bindman J, et al. Combination treatment with noradrenaline and serotonin reuptake inhibitors in resistant depression. Br J Psychiatry 1992; 161: Austin PPV, Souza FGM, Goodwin GM: Lithium augmentation in antidepressant-resistant patients: A quantitative analysis. Br J Psychiatry 1991; 159: Joffe RT, Levitt AJ, Sokolof ST, et al: Response to an open trial of a second SSRI in major depression. J Clin Psychiatry 1996; 57(3): Zhang W, Perry KW, Wong DT, et al: Synergistic effects of olanzapine and other antipsychotic agents in combination with fluoxetine on norepinephrine and dopamine release in rat prefrontal cortex. Neuropsychopharmacology 1998; 136: Sporn J, Ghaemi SN, Sambur MR, et al: Pramipexole augmentation in the treatment of unipolar and bipolar depression: a retrospective chart review. Ann Clin Psychiatry 2000; 12(3): Wharton R, Perel J, Dayton P, et al: A potential clinical use for methylphenidate with tricyclic antidepressants. Am J Psychiatry 1971; 127(12): Menza MA, Kaufman KR, Castellanos AM: Modafinil augmentation of antidepressant treatment in depression. J Clin Psychiatry 2000; 61(5): Landen M, Bjorling G, Agren H, et al: A randomized, double-blind, placebo-controlled trial of buspirone in combination with an SSRI in patients with treatment-refractory depression. J Clin Psychiatry 1998; 59(12): The Canadian Journal of CME / June 2003

Augmentation and Combination Strategies in Antidepressants treatment of Depression

Augmentation and Combination Strategies in Antidepressants treatment of Depression Augmentation and Combination Strategies in Antidepressants treatment of Depression Byung-Joo Ham, M.D. Department of Psychiatry Korea University College of Medicine Background The response rates reported

More information

Guilt Suicidality. Depression Co-Occurs with Medical Illness The rate of major depression among those with medical illness is significant.

Guilt Suicidality. Depression Co-Occurs with Medical Illness The rate of major depression among those with medical illness is significant. 1-800-PSYCH If you are obsessive-compulsive, dial 1 repeatedly If you are paranoid-delusional, dial 2 and wait, your call is being traced If you are schizophrenic, a little voice will tell you what number

More information

Medications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation

Medications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation Medications for Anxiety & Behavior in Williams Syndrome Christopher J. McDougle, M.D. Director, Lurie Center for Autism Professor of Psychiatry and Pediatrics Massachusetts General Hospital and MassGeneral

More information

Depression in Late Life

Depression in Late Life Depression in Late Life Robert Madan MD FRCPC Geriatric Psychiatrist Key Learnings Robert Madan MD FRCPC Key Learnings By the end of the session, participants will be able to List the symptoms of depression

More information

Treatment Options for Bipolar Disorder Contents

Treatment Options for Bipolar Disorder Contents Keeping Your Balance Treatment Options for Bipolar Disorder Contents Medication Treatment for Bipolar Disorder 2 Page Medication Record 5 Psychosocial Treatments for Bipolar Disorder 6 Module Summary 8

More information

Index. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers

Index. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) a-adrenergic blockers for PTSD, 798 b-adrenergic blockers for PTSD, 798 Adrenergic

More information

Clinical Guideline for the Management of Bipolar Disorder in Adults

Clinical Guideline for the Management of Bipolar Disorder in Adults Clinical Guideline for the Management of Bipolar Disorder in Adults Goal: To improve the quality of life of adults with bipolar disorder Identification and Treatment of Bipolar Disorder Criteria for Diagnosis:

More information

Facing Depression. Depression is a highly prevalent condition, Strategies for Initial Treatment and Beyond. In this article: Lisa s case

Facing Depression. Depression is a highly prevalent condition, Strategies for Initial Treatment and Beyond. In this article: Lisa s case Focus on CME at the Queen s Université University de Sherbrooke Facing Depression Strategies for Initial Treatment and Beyond By Jean-François Trudel, MD, FRCPC Lisa s case Lisa, 72, is married and has

More information

Manual of Clinical Psychopharmacology

Manual of Clinical Psychopharmacology Manual of Clinical Psychopharmacology Fourth Edition Alan F. Schatzberg, M.D. Kenneth T. Norris, Jr., Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Stanford University School

More information

DISEASES AND DISORDERS

DISEASES AND DISORDERS DISEASES AND DISORDERS 13. The mood (affective) disorders 99 14. The psychotic disorders: schizophrenia 105 15. The anxiety and somatoform disorders 111 16. Dementia and delirium 117 17. Alcohol and substance-related

More information

Suitable dose and duration of fluvoxamine administration to treat depression

Suitable dose and duration of fluvoxamine administration to treat depression PCN Psychiatric and Clinical Neurosciences 1323-13162003 Blackwell Science Pty Ltd 572April 2003 1098 Dose and duration of fluvoxamine S. Morishita and S. Arita 10.1046/j.1323-1316.2002.01098.x Original

More information

A Basic Approach to Mood and Anxiety Disorders in the Elderly

A Basic Approach to Mood and Anxiety Disorders in the Elderly A Basic Approach to Mood and Anxiety Disorders in the Elderly November 1 2013 Sarah Colman MD FRCPC Clinical Fellow, Geriatric Psychiatry Mount Sinai Hospital, University of Toronto Disclosure No conflict

More information

Pediatric Psychopharmacology

Pediatric Psychopharmacology Pediatric Psychopharmacology General issues to consider. Pharmacokinetic differences Availability of Clinical Data Psychiatric Disorders can be common in childhood. Early intervention may prevent disorders

More information

Mood Disorders.

Mood Disorders. Mood Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner

More information

GUIDELINES FOR THE USE OF PSYCHOACTIVE MEDICATIONS IN INDIVIDUALS WITH CO-OCCURRING SUBSTANCE USE DISORDERS

GUIDELINES FOR THE USE OF PSYCHOACTIVE MEDICATIONS IN INDIVIDUALS WITH CO-OCCURRING SUBSTANCE USE DISORDERS City and County of San Francisco Mayor Gavin Newsom Department of Public Health Community Behavioral Health Services 1380 Howard Street 5 th Floor San Francisco, CA 94103 GUIDELINES FOR THE USE OF PSYCHOACTIVE

More information

Mentoring Session: Participant Cases

Mentoring Session: Participant Cases Handout for the Neuroscience Education Institute (NEI) online activity: Mentoring Session: Participant Cases The Case: 55-year-old patient with depression and anxiety The Question: What to do when antidepressants

More information

Department of Psychiatry & Behavioral Sciences. University of Texas Medical Branch

Department of Psychiatry & Behavioral Sciences. University of Texas Medical Branch Depression in Childhood: Advances and Controversies in Treatment Karen Dineen Wagner, MD, PhD Marie B. Gale Centennial Professor & Vice Chair Department of Psychiatry & Behavioral Sciences Director, Division

More information

Psychiatry in Primary Care: What is the Role of Pharmacist?

Psychiatry in Primary Care: What is the Role of Pharmacist? Psychiatry in Primary Care: What is the Role of Pharmacist? Benjamin Chavez, PharmD, BCPP, BCACP Clinical Associate Professor Director of Behavioral Health Pharmacy Services January 12, 2019 Disclosure

More information

Where to from Here? Evidence-Based Strategies for Treatment of Refractory Depression

Where to from Here? Evidence-Based Strategies for Treatment of Refractory Depression Where to from Here? Evidence-Based Strategies for Treatment of Refractory Depression Michael D. Jibson, MD, PhD Professor of Psychiatry University of Michigan Major Depression #1 WHO cause of disability

More information

How to treat depression with medication: Some rules of thumb

How to treat depression with medication: Some rules of thumb How to treat depression with medication: Some rules of thumb R. Hamish McAllister-Williams, MD, PhD, FRCPsych Reader in Clinical Psychopharmacology Newcastle University Hon. Consultant Psychiatrist Regional

More information

Anti-Depressant Medications

Anti-Depressant Medications Anti-Depressant Medications A Introduction: This topic may be a little bit underestimated here in Jordan, while in western countries it has more significance. The function of anti-depressants is to change

More information

September 26 28, 2013 Westin Tampa Harbour Island. Co-sponsored by

September 26 28, 2013 Westin Tampa Harbour Island. Co-sponsored by September 26 28, 2013 Westin Tampa Harbour Island Co-sponsored by Best Practices in the Management of Bipolar Disorder Robert M. A. Hirschfeld, MD University of Texas Medical Branch Galveston, TX Peter

More information

Depression in Pregnancy

Depression in Pregnancy TREATING THE MOTHER PROTECTING THE UNBORN A MOTHERISK Educational Program The content of this program reflects the expression of a consensus on emerging clinical and scientific advances as of the date

More information

1 1 Evidence-based pharmacotherapy of major depressive disorder. Michael J. Ostacher, Jeffrey Huffman, Roy Perlis, and Andrew A.

1 1 Evidence-based pharmacotherapy of major depressive disorder. Michael J. Ostacher, Jeffrey Huffman, Roy Perlis, and Andrew A. 1 1 Evidence-based pharmacotherapy of major depressive disorder Michael J. Ostacher, Jeffrey Huffman, Roy Perlis, and Andrew A. Nierenberg Massachusetts General Hospital and Harvard University, Boston,

More information

Management of SSRI Induced Sexual Dysfunction. Serotonin Reuptake Inhibitors*

Management of SSRI Induced Sexual Dysfunction. Serotonin Reuptake Inhibitors* Management of SSRI Induced Sexual Dysfunction John J. Miller, M.D. Medical Director, Center for Health and WellBeing Exeter, NH Serotonin Reuptake Inhibitors* fluoxetine clomipramine sertraline paroxetine

More information

Depression and the Role of L-methylfolate

Depression and the Role of L-methylfolate Depression and the Role of L-methylfolate Depression is a chronic and recurrent disease affecting more than 18 million people in the United States, ranking it, along with heart disease, cancer and diabetes,

More information

Introduction to Drug Treatment

Introduction to Drug Treatment Introduction to Drug Treatment LPT Gondar Mental Health Group www.le.ac.uk Introduction to Psychiatric Drugs Drugs and Neurotransmitters 5 Classes of Psychotropic medications Mechanism of action Clinical

More information

Joe Barton, MA, LPC, NCC National Certified Counselor Faculty Associate, TTUHSC Amarillo Family Medicine Department Barton Behavioral Health

Joe Barton, MA, LPC, NCC National Certified Counselor Faculty Associate, TTUHSC Amarillo Family Medicine Department Barton Behavioral Health Joe Barton, MA, LPC, NCC National Certified Counselor Faculty Associate, TTUHSC Amarillo Family Medicine Department Barton Behavioral Health Solutions, PLLC www.bartoncbt.com Academic and Pop-Culture

More information

Mixing and Matching: Layering Medications as Family Physicians

Mixing and Matching: Layering Medications as Family Physicians Mixing and Matching: Layering Medications as Family Physicians Family Medicine Forum Vancouver, B.C. November 9-12, 2016. Jon Davine, CCFP, FRCP(C) McMaster University Objectives Discuss different examples

More information

Optimal Use of Antidepressants: Focusing on SNRI, NDRI and SSRE

Optimal Use of Antidepressants: Focusing on SNRI, NDRI and SSRE Optimal Use of Antidepressants: Focusing on SNRI, NDRI and SSRE Chan-Hyung Kim, MD Severance Mental Health Hospital Institute of Behavioral Science in Medicine Diagnostic Criteria Pyramid Etiologic Pathophysiologic

More information

Change Your Brain, Change Your Life. The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness

Change Your Brain, Change Your Life. The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness Change Your Brain, Change Your Life The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness Daniel G Amen Three Rivers Press New York Appendix Medication 1.

More information

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines

More information

Study Guide Unit 3 Psych 2022, Fall 2003

Study Guide Unit 3 Psych 2022, Fall 2003 Psychological Disorders: General Study Guide Unit 3 Psych 2022, Fall 2003 1. What are psychological disorders? 2. What was the main treatment for some psychological disorders prior to the 1950 s? 3. What

More information

Drugs, Society and Behavior

Drugs, Society and Behavior SOCI 270 Drugs, Society and Behavior Spring 2016 Professor Kurt Reymers, Ph.D. Chapter 8 Medication for Mental Disorders 1. Mental Disorders: a. The Medical Model Model: symptoms diagnosis determination

More information

Clinical Perspective on Conducting TRD Studies. Hans Eriksson, M.D., Ph.D., M.B.A. Chief Medical Specialist, H. Lundbeck A/S Valby, Denmark

Clinical Perspective on Conducting TRD Studies. Hans Eriksson, M.D., Ph.D., M.B.A. Chief Medical Specialist, H. Lundbeck A/S Valby, Denmark Clinical Perspective on Conducting TRD Studies Hans Eriksson, M.D., Ph.D., M.B.A. Chief Medical Specialist, H. Lundbeck A/S Valby, Denmark Overview of Presentation Treatment-Resistant Depression (TRD)

More information

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally

More information

Clinical Significance of Anxiety in Depressed Patients Selecting an Antidepressant

Clinical Significance of Anxiety in Depressed Patients Selecting an Antidepressant The Clinical Significance of Anxiety Disorders and the DSM-5 Anxious Distress Specifier in Depressed Patients Clinical Significance of Anxiety in Depressed Patients Selecting an Antidepressant Rhode Island

More information

Diagnosis & Management of Major Depression: A Review of What s Old and New. Cerrone Cohen, MD

Diagnosis & Management of Major Depression: A Review of What s Old and New. Cerrone Cohen, MD Diagnosis & Management of Major Depression: A Review of What s Old and New Cerrone Cohen, MD Why You re Treating So Much Mental Health 59% of Psychiatrists Are Over the Age of 55 AAMC 2014 Physician specialty

More information

Antidepressant Selection in Primary Care

Antidepressant Selection in Primary Care Antidepressant Selection in Primary Care R E B E C C A D. L E W I S, D O O O A S U M M E R C M E B R A N S O N, M O 1 5 A U G U S T 2 0 1 5 Objectives Understand the epidemiology of depression. Recognize

More information

In Memory of the American Tragedy

In Memory of the American Tragedy Evolving Pharmacologic Strategies in the Treatment of PTSD John J. Miller, M.D. Medical Director Brain Health Exeter, NH In Memory of the American Tragedy September 11, 2001 jjm@brain-health.co 1 Overview

More information

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX A Adderall Counterfeit, 31 addiction, internet CBT, 55 ADHD Adjunctive Guanfacine, 11 Counterfeit Adderall, 31 Developmental Trajectory and Risk Factors, 5 Dopamine Transporter Alterations, 14 Extended-Release

More information

Presentation is Being Recorded

Presentation is Being Recorded Integrated Care for Depression & Anxiety Psychotropic Medication Management for Primary Care Providers Los Angeles County Department of Mental Health September 20, 2011 Presentation is Being Recorded Please

More information

Affective Disorders.

Affective Disorders. Affective Disorders http://www.bristol.ac.uk/medicalschool/hippocrates/psychethics/ Affective Disorders Depression Mania / Hypomania Bipolar mood disorder Recurrent depression Persistent mood disorders

More information

9/20/2011. Integrated Care for Depression & Anxiety: Psychotropic Medication Management for PCPs. Presentation is Being Recorded

9/20/2011. Integrated Care for Depression & Anxiety: Psychotropic Medication Management for PCPs. Presentation is Being Recorded Integrated Care for Depression & Anxiety Psychotropic Medication Management for Primary Care Providers Los Angeles County Department of Mental Health September 20, 2011 Presentation is Being Recorded Please

More information

Psychobiology Handout

Psychobiology Handout Nsg 85A / Psychiatric Page 1 of 7 Psychobiology Handout STRUCTURE AND FUNCTION OF THE BRAIN Psychiatric illness and the treatment of psychiatric illness alter brain functioning. Some examples of this are

More information

The cientificworldjournal. Hiroaki Hori and Hiroshi Kunugi. 1. Introduction

The cientificworldjournal. Hiroaki Hori and Hiroshi Kunugi. 1. Introduction The Scientific World Journal Volume 2012, Article ID 372474, 8 pages doi:10.1100/2012/372474 The cientificworldjournal Clinical Study The Efficacy of Pramipexole, a Dopamine Receptor Agonist, as an Adjunctive

More information

KEY MESSAGES. It is often under-recognised and 30-50% of MDD cases in primary care and medical settings are not detected.

KEY MESSAGES. It is often under-recognised and 30-50% of MDD cases in primary care and medical settings are not detected. KEY MESSAGES Major depressive disorder (MDD) is a significant mental health problem that disrupts a person s mood and affects his psychosocial and occupational functioning. It is often under-recognised

More information

Affective or Mood Disorders. Dr. Alia Shatanawi March 12, 2018

Affective or Mood Disorders. Dr. Alia Shatanawi March 12, 2018 Affective or Mood Disorders Dr. Alia Shatanawi March 12, 2018 Affective or Mood Disorders Reactive Depression. Secondary: Medical Neurological Drugs Major (Endogenous) Depression = Unipolar: Depressed

More information

Antidepressant Medication Strategies We ve Come a Long Way or Have We? Who Writes Prescriptions for Psychotropic Medications. Biological Psychiatry

Antidepressant Medication Strategies We ve Come a Long Way or Have We? Who Writes Prescriptions for Psychotropic Medications. Biological Psychiatry Antidepressant Medication Strategies We ve Come a Long Way or Have We? Joe Wegmann, PD, LCSW The PharmaTherapist Joe@ThePharmaTherapist.com 504.587.9798 www.pharmatherapist.com Are you receiving our free

More information

Optimal Treatment of Anxiety Disorders

Optimal Treatment of Anxiety Disorders Optimal Treatment of Anxiety Disorders Franklin R. Schneier, MD Co-Director, Anxiety Disorders Clinic Research Psychiatrist New York State Psychiatric Institute Special Lecturer in Psychiatry Columbia

More information

Guidelines MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD)

Guidelines MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD) MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD) Guidelines CH Lim, B Baizury, on behalf of Development Group Clinical Practice Guidelines Management of Major Depressive Disorder A. Introduction Major depressive

More information

Treatment-resistant depression in primary care

Treatment-resistant depression in primary care Treatment-resistant depression in primary care Interprofessional CME, October 2017 Brian J. Mickey, MD, PhD Associate Professor School of Medicine Department of Psychiatry Disclosures Speakers bureau:

More information

Panic disorder is a chronic and recurrent illness associated

Panic disorder is a chronic and recurrent illness associated CLINICAL PRACTICE GUIDELINES Management of Anxiety Disorders. Panic Disorder, With or Without Agoraphobia Epidemiology Panic disorder is a chronic and recurrent illness associated with significant functional

More information

The Safety and Efficacy of Ondansetron in the Treatment of Obsessive Compulsive Disorder

The Safety and Efficacy of Ondansetron in the Treatment of Obsessive Compulsive Disorder Duquesne University Duquesne Scholarship Collection Graduate Student Research Symposium The 4th Annual Graduate Student Research Symposium September 19, 2017 The Safety and Efficacy of Ondansetron in the

More information

Bipolar Disorder 4/6/2014. Bipolar Disorder. Symptoms of Depression. Mania. Depression

Bipolar Disorder 4/6/2014. Bipolar Disorder. Symptoms of Depression. Mania. Depression Bipolar Disorder J. H. Atkinson, M.D. Professor of Psychiatry HIV Neurobehavioral Research Programs University of California, San Diego KETHEA, Athens Slides courtesy of John Kelsoe, M.D. Bipolar Disorder

More information

Anxiety Disorders.

Anxiety Disorders. Anxiety Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner

More information

Family Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University

Family Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University APPROACH TO DEPRESSION IN PRIMARY CARE Family Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University DISCLOSURE Speaker/Presenter Disclosure

More information

Psychiatry curbside: Answers to a primary care doctor s top mental health questions

Psychiatry curbside: Answers to a primary care doctor s top mental health questions Psychiatry curbside: Answers to a primary care doctor s top mental health questions April 27, 2018 Laurel Ralston, DO Psychiatrist, Taussig Cancer Institute Objectives Review current diagnostic and prescribing

More information

Evidence-Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition

Evidence-Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition SPECIAL ARTICLE Psychiatry & Psychology http://dx.doi.org/10.3346/jkms.2014.29.4.468 J Korean Med Sci 2014; 29: 468-484 -Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition

More information

Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D.

Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D. Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D. Sources: National Institute of Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), and from the American Psychological Association

More information

Reducing the Anxiety of Pediatric Anxiety Part 2: Treatment

Reducing the Anxiety of Pediatric Anxiety Part 2: Treatment Reducing the Anxiety of Pediatric Anxiety Part 2: Treatment Lisa Lloyd Giles, MD Medical Director, Behavioral Consultation, Crisis, and Community Services Primary Children s Hospital Associate Professor,

More information

Treatment strategies in major depression What to use when?

Treatment strategies in major depression What to use when? Treatment strategies in major depression What to use when? Michael Bauer, MD, PhD Professor and Chair of Psychiatry University Hospital Carl Gustav Carus Technische Universität Dresden Germany First-line

More information

Depression Workshop 26 January 2007

Depression Workshop 26 January 2007 Depression Workshop 26 January 2007 Leslie G Walker Professor of Cancer Rehabilitation Donald M Sharp Senior Lecturer in Behavioural Oncology Mary B Walker Senior Clinical and Research Nurse Specialist

More information

PTSD: Treatment Opportunities

PTSD: Treatment Opportunities PTSD: Treatment Opportunities Professor Malcolm Hopwood Department of Psychiatry University of Melbourne Professorial Psychiatry Unit, Albert Road Clinic DSM 5: PTSD CRITERION A exposure to: actual or

More information

PHARMACODYNAMICS OF ANTIDEPRESSANTS MOOD STABILIZING AGENTS ANXIOLYTICS SEDATIVE-HYPNOTICS

PHARMACODYNAMICS OF ANTIDEPRESSANTS MOOD STABILIZING AGENTS ANXIOLYTICS SEDATIVE-HYPNOTICS PHARMACODYNAMICS OF ANTIDEPRESSANTS MOOD STABILIZING AGENTS ANXIOLYTICS SEDATIVE-HYPNOTICS Yogesh Dwivedi, Ph.D. Assistant Professor of Psychiatry and Pharmacology Psychiatric Institute Department of Psychiatry

More information

Pharmacy Prior Authorization GMH/SA and Non-Title 19/21 SMI Non-Formulary and Prior Authorization Guidelines

Pharmacy Prior Authorization GMH/SA and Non-Title 19/21 SMI Non-Formulary and Prior Authorization Guidelines Non-Formulary Behavioral Health Medications ADHD medications for children under The patient must have a diagnosis for which the requested medication is: o Approved based on FDA indication and limits; OR

More information

Bipolar Disorder in Youth

Bipolar Disorder in Youth Bipolar Disorder in Youth Janet Wozniak, M.D. Associate Professor of Psychiatry Director, Pediatric Bipolar Disorder Research Program Harvard Medical School Massachusetts General Hospital Pediatric-Onset

More information

PSYCHIATRIC MANAGEMENT IN PRIMARY CARE. Dr Fayyaz Khan MBBS, MRCPsych, MSc Consultant Psychiatrist (Locum) Mersey Care NHS Trust

PSYCHIATRIC MANAGEMENT IN PRIMARY CARE. Dr Fayyaz Khan MBBS, MRCPsych, MSc Consultant Psychiatrist (Locum) Mersey Care NHS Trust PSYCHIATRIC MANAGEMENT IN PRIMARY CARE Dr Fayyaz Khan MBBS, MRCPsych, MSc Consultant Psychiatrist (Locum) Mersey Care NHS Trust Areas to cover Mood Disorders Anxiety Disorders Miscellaneous Conditions

More information

Managing Anxiety Disorder in Primary Care

Managing Anxiety Disorder in Primary Care Saturday General Session Managing Anxiety Disorder in Primary Care Chris Ticknor, MD Private Practice, Psychiatry Adjunct Professor of Psychiatry UT Health Science Center at San Antonio San Antonio, Texas

More information

Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder,

Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder, Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder, Journal of the Academy of Child and Adolescent Psychiatry, 1997 Primary Authors: Jon McClellan MD

More information

Psychopharmacology: A Comprehensive Review

Psychopharmacology: A Comprehensive Review Psychopharmacology: A Comprehensive Review 1) The association between a chemical compound and its biological activity, pioneered by Bovet and colleagues in the 1930s is known as a) Symbiosis b) Structure-activity

More information

MEDICATION ALGORITHM FOR ANXIETY DISORDERS

MEDICATION ALGORITHM FOR ANXIETY DISORDERS Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences MEDICATION ALGORITHM FOR ANXIETY DISORDERS RYAN KIMMEL, MD MEDICAL DIRECTOR HOSPITAL PSYCHIATRY UNIVERSITY OF WASHINGTON

More information

Objectives. Objectives. A practice review. 02-Nov-16 MAJOR DEPRESSIVE DISORDER: NEW DEVELOPMENTS AND PRACTICAL IMPLICATIONS

Objectives. Objectives. A practice review. 02-Nov-16 MAJOR DEPRESSIVE DISORDER: NEW DEVELOPMENTS AND PRACTICAL IMPLICATIONS MAJOR DEPRESSIVE DISORDER: NEW DEVELOPMENTS AND PRACTICAL IMPLICATIONS Jon-Paul Khoo What is treatment resistance really? Database review 328 consecutive non-remitted MDD patients referred for private

More information

Depression PROTOCOL 3

Depression PROTOCOL 3 PROTOCOL 3 Depression Kimberly Yonkers 1,2,3 1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University

More information

Reviews/Evaluations. Use of Selective Serotonin Reuptake Inhibitors in Pediatric Patients. Pharmacotherapeutic Options

Reviews/Evaluations. Use of Selective Serotonin Reuptake Inhibitors in Pediatric Patients. Pharmacotherapeutic Options Reviews/Evaluations Use of Selective Serotonin Reuptake Inhibitors in Pediatric Patients Childhood major depressive disorder (MDD) has become recognized as a serious and common illness affecting between

More information

ESCITALOPRAM. THERAPEUTICS Brands Lexapro see index for additional brand names. Generic? Yes

ESCITALOPRAM. THERAPEUTICS Brands Lexapro see index for additional brand names. Generic? Yes ESCITALOPRAM THERAPEUTICS Brands Lexapro see index for additional brand names Generic? Yes Class SSRI (selective serotonin reuptake inhibitor); often classified as an antidepressant, but it is not just

More information

Mental Health Nursing: Mood Disorders. By Mary B. Knutson, RN, MS, FCP

Mental Health Nursing: Mood Disorders. By Mary B. Knutson, RN, MS, FCP Mental Health Nursing: Mood Disorders By Mary B. Knutson, RN, MS, FCP A Definition of Mood Prolonged emotional state that influences the person s whole personality and life functioning Adaptive Functions

More information

Antidepressant Selection in Primary Care

Antidepressant Selection in Primary Care Antidepressant Selection in Primary Care Rebecca D. Lewis, DO OOA Summer CME Oklahoma City, OK 6 August 2017 Objectives Understand the epidemiology of depression. Recognize factors to help choose antidepressants.

More information

Disclosure Information

Disclosure Information Disclosure Information I have no financial relationships to disclose. I will discuss the off label use of several depression and anxiety medications in pediatric population Pediatric Depression & Anxiety

More information

PRACTICAL MANAGEMENT OF DEPRESSION IN OLDER ADULTS. Lee A. Jennings, MD MSHS Assistant Professor Division of Geriatrics, UCLA

PRACTICAL MANAGEMENT OF DEPRESSION IN OLDER ADULTS. Lee A. Jennings, MD MSHS Assistant Professor Division of Geriatrics, UCLA CASE #1 PRACTICAL MANAGEMENT OF DEPRESSION IN OLDER ADULTS Lee A. Jennings, MD MSHS Assistant Professor Division of Geriatrics, UCLA OBJECTIVES Epidemiology Presentation in older adults Assessment Treatment

More information

Is Depression management getting you down? G. Michael Allan Director Programs and Practice Support, CFPC Professor, Family Med, U of A

Is Depression management getting you down? G. Michael Allan Director Programs and Practice Support, CFPC Professor, Family Med, U of A Is Depression management getting you down? G. Michael Allan Director Programs and Practice Support, CFPC Professor, Family Med, U of A Faculty/Presenter Disclosures Faculty: Mike Allan Salary: College

More information

Adult Depression - Clinical Practice Guideline

Adult Depression - Clinical Practice Guideline 1 Adult Depression - Clinical Practice Guideline 05/2018 Diagnosis and Screening Diagnostic criteria o Please refer to Attachment A Screening o The United States Preventative Services Task Force (USPSTF)

More information

Non-A, non-b=hcv; IFN/RBV; DSM-5/Ham-D, OLT; SSRI, P450

Non-A, non-b=hcv; IFN/RBV; DSM-5/Ham-D, OLT; SSRI, P450 James A. Bourgeois, O.D., M.D. Vice Chair Clinical Affairs and Director, CL Service University of California San Francisco Non-A, non-b=hcv; IFN/RBV; DSM-5/Ham-D, OLT; SSRI, P450 Localize! Sequence! 1

More information

Kelly Godecke, MD Department of Psychiatry University of Utah

Kelly Godecke, MD Department of Psychiatry University of Utah Kelly Godecke, MD Department of Psychiatry University of Utah Epidemiology and Impact -module 2 session 1 overview of mood disorders Diagnostic Criteria of Bipolar Disorders Medications Used in Bipolar

More information

Treating treatment resistant depression

Treating treatment resistant depression Treating treatment resistant depression These slides are the intellectual property of Ian Anderson and must not be reproduced Ian Anderson Neuroscience and Psychiatry Unit University of Manchester and

More information

A new Anatomy of Melancholy: rethinking depression and resilience

A new Anatomy of Melancholy: rethinking depression and resilience A new Anatomy of Melancholy: rethinking depression and resilience Prof Declan McLoughlin Dept of Psychiatry & Trinity College Institute of Neuroscience Trinity College Dublin St Patrick s University Hospital

More information

Anxiolytics. What s new? Lindsey Sinclair

Anxiolytics. What s new? Lindsey Sinclair Anxiolytics Lindsey Sinclair David Nutt What s new? pregabalin has gained a licence for the treatment of generalized anxiety disorder new data support the use of escitalopram in several anxiety disorders

More information

Final Exam PSYC2022. Fall (1 point) True or False. The DSM-IV describes the symptoms of acute intoxication with cannabis.

Final Exam PSYC2022. Fall (1 point) True or False. The DSM-IV describes the symptoms of acute intoxication with cannabis. Final Exam PSYC2022 Fall 1998 (2 points) Give 2 reasons why it is important for psychological disorders to be accurately diagnosed. (1 point) True or False. The DSM-IV describes the symptoms of acute intoxication

More information

Objectives. DSM-V Changes: Elimination of Multiaxial Diagnostic System

Objectives. DSM-V Changes: Elimination of Multiaxial Diagnostic System Conflicts of Interest I have no conflicts to disclose. 2014 Updates to the Updates in Pharmacotherapy Webinar Psychiatry Updates for Pharmacotherapy Specialists Jacintha S. Cauffield, Pharm.D., BCPS Associate

More information

Depression in adults: treatment and management

Depression in adults: treatment and management 1 2 3 4 Depression in adults: treatment and management 5 6 7 8 Appendix V3: recommendations that have been deleted of changed from 2009 guideline Depression in adults: Appendix V3 1 of 22 1 Recommendations

More information

Tachyphylaxis/tolerance to antidepressants in treatment of dysthymia: Results of a retrospective naturalistic chart review studypcn_

Tachyphylaxis/tolerance to antidepressants in treatment of dysthymia: Results of a retrospective naturalistic chart review studypcn_ Psychiatry and Clinical Neurosciences 2011; 65: 499 504 doi:10.1111/j.1440-1819.2011.02231.x Regular Article Tachyphylaxis/tolerance to antidepressants in treatment of dysthymia: Results of a retrospective

More information

3. Depressione unipolare

3. Depressione unipolare 3. Depressione unipolare Depressione unipolare con mancata risposta al trattamento con SSRI Question: Should switching from SSRIs to another antidepressant class vs switching within class (SSRIs) be used

More information

Psychopharmacology. Psychopharmacology. Hamish McAllister-Williams Reader in Clinical. Department of Psychiatry, RVI

Psychopharmacology. Psychopharmacology. Hamish McAllister-Williams Reader in Clinical. Department of Psychiatry, RVI Regional Affective Disorders Service Psychopharmacology Northumberland, Tyne and Wear NHS Trust Hamish McAllister-Williams Reader in Clinical Psychopharmacology Department of Psychiatry, RVI Intro NOT

More information

TRANYLCYPROMINE. THERAPEUTICS Brands Parnate see index for additional brand names. Generic? Yes

TRANYLCYPROMINE. THERAPEUTICS Brands Parnate see index for additional brand names. Generic? Yes TRANYLCYPROMINE THERAPEUTICS Brands Parnate see index for additional brand names Generic? Yes Class Monoamine oxidase inhibitor (MAOI) Commonly Prescribed for (bold for FDA approved) Major depressive episode

More information

Contemporary Psychiatric-Mental Health Nursing. Psychopharmacology. Psychopharmacology - continued. Chapter 7 The Science of Psychopharmacology

Contemporary Psychiatric-Mental Health Nursing. Psychopharmacology. Psychopharmacology - continued. Chapter 7 The Science of Psychopharmacology Contemporary Psychiatric-Mental Health Nursing Chapter 7 The Science of Psychopharmacology Psychopharmacology A primary treatment mode of psychiatric-mental health nursing care Psychopharmacology - continued

More information

Pharmacotherapy of OCD

Pharmacotherapy of OCD Pharmacotherapy of OCD Michael Jenike, MD Professor of Psychiatry Harvard Medical School Founder, OCD Clinic & Research Unit Massachusetts General Hospital Founder, OCD Institute Mclean Hospital Jenike@comcast.net

More information

MMG004 GUIDELINES FOR THE USE OF HIGH DOSE VENLAFAXINE AND THE COMBINATION OF VENLAFAXINE AND MIRTAZAPINE IN THE TREATMENT OF DEPRESSION

MMG004 GUIDELINES FOR THE USE OF HIGH DOSE VENLAFAXINE AND THE COMBINATION OF VENLAFAXINE AND MIRTAZAPINE IN THE TREATMENT OF DEPRESSION MMG004 GUIDELINES FOR THE USE OF HIGH DOSE VENLAFAXINE AND THE COMBINATION OF VENLAFAXINE AND MIRTAZAPINE IN THE TREATMENT OF DEPRESSION Page 1 of 13 Table of Contents Why we need this Guideline... 3 What

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Age as factor in selective mutism, 623 as factor in social phobia, 623 Agoraphobia, 593 600 described, 594 596 DSM-V changes related to,

More information

Comorbidity of Depression and Other Diseases

Comorbidity of Depression and Other Diseases Comorbidity of Depression and Other Diseases JMAJ 44(5): 225 229, 2001 Masaru MIMURA Associate Professor, Department of Psychiatry, Showa University, School of Medicine Abstract: This paper outlines the

More information

Consultant Pharmacist Approach to Major Depressive Disorder

Consultant Pharmacist Approach to Major Depressive Disorder Consultant Pharmacist Approach to Major Depressive Disorder ALAN OBRINGER RPH, CPH, CGP PRESIDENT/OWNER GUARDIAN PHARMACY OF ORLANDO Objectives What is Depression? Discuss the epidemiology of depression

More information