Document Title Pharmacological Management of Generalised Anxiety Disorder
|
|
- Aldous Cunningham
- 6 years ago
- Views:
Transcription
1 Document Title Pharmacological Management of Generalised Anxiety Disorder Document Description Document Type Policy Service Application Trust Wide Version 1.1 Policy Reference no. POL 201 Lead Author(s) This policy was developed by members of the Medicines Management Committee Change History Version Control Version Date Comments /12/2011 Initial document drafted and developed in line with comments from Dudley and Walsall Mental Health Partnership NHS Trusts Medicines Management Committee /02/2012 Policy Agreed for ratification by Policies and Procedures Focus Group and formally ratified by Governance and Quality Committee 15/02/ /01/2016 Guidance updated and reviewed by MMC. Ratified by Policies and Procedures Group 31/03/2016 Link with National Standards National Health Service Litigation Authority Care Quality Commission National Institute for Health and Clinical Excellence National Patient Safety Agency West Midlands Quality Review Essence of Care Aims Standards Key Dates Day Month Year Ratification Date Review Date
2 Executive Summary Sheet Document Title: Pharmacological Management of Generalised Anxiety Disorder Please tick ( ) as appropriate This is a new document within the Trust This is a revised document within the Trust What is the purpose of this document? To promote evidence based prescribing in the treatment of generalised anxiety disorder What key issues does this document explore? The pharmacological and non-pharmacological treatment of generalised anxiety disorder. Who is this document aimed at? Doctors and non-medical prescibers. What other policies, guidance and directives should this document be read in conjunction with? British National Formulary (BNF) Medicines Management Policy Trust policies and national guidance on the management of violence and aggression Resuscitation Policy Consent to treatment guidance How and when will this document be reviewed? This policy will be subject to review every 2 years. This review will be coordinated by nominated members of the Medicines Management Committee. 2
3 Document Index Pg 1 Introduction 4 2 Scope 4 3 Roles and Responsibilites 4 4 Support Training 4 5 Prescribing Guidance for Generalised Anxiety Disorder 5 6 References 6 Document Appendices Pg 1 Specialist pharmacological treatment for generalised anxiety 8 disorder 2 Prescribing guidance for generalised anxiety disorder 10 3
4 1. Introduction 1.1 The prescribing guidance for generalised anxiety disorder is designed to support the treatment of this disorder in primary and secondary care. It is intended to outline what is perceived as best practice and specifies the prescribing responsibilities of clinicians within primary and secondary care. 2. Scope 2.1 The prescribing guidance covers the pharmacological treatment of generalised anxiety disorder including non-pharmacological therapy. 2.2 This policy applies to all Dudley and Walsall Mental Health Partnership NHS Trust staff and is of particular interest in relation to those involved within the management of generalised anxiety disorder within primary and secondary care. 3. Roles and Responsibilities / Duties 3.1 The Chief Pharmacist and Medical director hold overarching responsibility for ensuring the development, management and implementation of a policy regarding the pharmacological treatment of generalised anxiety disorder. 3.2 The Heads of Medicines Management with local CCGs are responsible for the appropriate pharmacological management of generalised anxiety disorder within their relevant organisations. 3.3 Prescribers should ensure that they are aware of the recommendations and adhere to the guidance outlined within this document. Adherence will be monitored by audit and regular review of patient treatment as inpatients. 4. Support Training 4.1 There is no formal training available into the pharmacological management of Generalised Anxiety Disorder. 4.2 This guidance will be disseminated to all Consultants and teams across the organisation. 4
5 5. Prescribing Guidance for Generalised Anxiety Disorder 5.1 Pharmacological interventions Most evidence for the efficacy of treatment in GAD is based on short-term trials. The choice of medication can depend on the potential adverse effect profile, the presence of co-existent depressive symptoms and the need for a rapid onset of action Benzodiazepines are suitable for short term use only and can be effective within 15-60mins NICE recommend that antidepressants should be the only pharmacological intervention used in the long term management of GAD. Antidepressants can take up to 4 weeks to show effectiveness but clinical effectiveness has been noted after as little as 2 weeks. 5.2 n-medical interventions Psychological therapies (CBT) and self help strategies have been shown to be effective and should be offered to patients instead of pharmacological therapies or with pharmacological therapies where appropriate. There is also limited evidence to suggest that regular exercise can be beneficial (NICE 2011) 5.3 Acute Treatment (up to 4 weeks) should only be used short term in severe disabling and stressful anxiety. longer than 2 4 weeks with regular reviews. Benzodiazepines are effective and rapid in the treatment of GAD. However the benzodiazepines have limited efficacy against co-morbid depressive symptoms. The problems of tolerance, dependence and potential withdrawal symptoms limit the use of the benzodiazepines to short term use (up to 4 weeks). Treatment with a benzodiazepine should be tapered off after 2-4 weeks when the antidepressant becomes effective. 5.4 First Line Pharmacological treatment The SSRIs sertraline - (off license indication, but recommended first line by CKS), citalopram, fluoxetine and paroxetine are recommended as first line treatments. Paroxetine and escitalopram are licensed for the treatment of GAD and have shown efficacy in relapse prevention studies and have demonstrated long-term efficacy with response rates continuing to increase over 6 months of treatment. The current NICE guidance recommends the use of an SSRI in the treatment of GAD acknowledging that not all SSRIs are licensed for this indication. Review patient in first week, counsel patient out initiation of SSRIs e.g. symptoms may get worse initially, may take a few weeks to start showing benefit. If in 2 months, no improvement, titrate to optimum dose or consider switching to another SSRI or SNRI (venlafaxine and duloxetine licensed for GAD) 5.5 Second Line agents: 5
6 If SSRIs not effective (titrated to optimal dose and switched to alternative SSRI), then consider SNRI (venlafaxine and duloxetine) 5.6 Third Line: If SSRI / SNRI not effective / not tolerated, consider prescribing pregabalin (this should be categorised under specialist treatments and only initiated by a specialist and is not mentioned in NICE guidance). 5.7 Other licensed agents include (Initiation by specialists only): Trazodone, buspirone, hydroxyzine The agents should only be used by specialists for the treatment of GAD. These agents should only be used where patients have failed to respond to first and second line agents or where their use is considered inappropriate. The above agents are not recommended as first or second line agents due to either a lack of efficacy data. Hydroxyzine has been shown in trials to be similar in efficacy to the benzodiazepines without discontinuation symptoms. Hydroxyzine is indicated for short term use only as there is no long term data. Safety information EMA (April 2015), hydroxyzine is associated with a small risk of QT prolongation. The EMA make the following recommendations: Hydroxyzine is contraindicated in patients with a prolonged QT interval Avoid use in the elderly due to increased susceptibility of side effects Consider the risks of QT prolongation and Torsade de Pointes in patients taking medications with lower heart rate or plasma potassium concentration In the elderly the maximum dose used in 50mg The lowest effective dose for the shortest period of time should be prescribed 5.8 Specialist Treatment Patients may take up to 6 months for remission of symptoms following treatment with pharmacotherapy. If a patient fails to respond to first, or second line agents then, following a review of the diagnosis, alternative agents as listed above should be considered (see specialist pharmacological treatment for generalised anxiety disorder) Augmentation strategies have limited supporting evidence for use in the treatment of GAD and care should be taken to minimise adverse events when using this approach. 6
7 6. References See Guidance Baldwin D S, Anderson I M, Nutt D J, et al. Evidenced-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J of Psychopharmacology 2005; 19(6): Baldwin D S, Polkinghorn C. Evidence-based pharmacotherapy of generalised anxiety disorder. International J of Neuropsychopharmacology 2005; 8: BNF 57, Chapter 4. BMJ Group/RPSGB Publishing. March 2009 Carter N J, McCormack P L. Duloxetine a review of its use in the treatment of generalized anxiety disorder. CNS Drugs 2009; 23 (6): Clinical Knowledge Summaries (Generalised anxiety disorder). Found at: accessed 21/01/2016 Feltner D, Crockatt J, Dubovsky S, et al. A randomized, double-blind, placebo-controlled, fixed-dose, multicenter study of pregabalin in patients with generalized anxiety disorder. J Clin Psychopharmacol 2003;23: Flint A J. Generalised anxiety disorder in elderly patients. Drugs aging 2005; 22(2): Fricchione G. Generalized Anxiety Disorder. N Engl J Med 2004; 351: JOINT FORMULARY COMMITTEE, British National Formulary. 69. London: BMJ Group and Pharmaceutical Press. Kapczinski F F K, Silva de Lima M, Santos Souza J J S S, et al. Antidepressants for generalised anxiety disorder (review). Cochrane Database Syst Rev Montgomery S A. Sheehan D V, Meoni P et al. Characterization of the longitudinal course of improvement in generalised anxiety disorder during long-term treatment with Venlafaxine XR. J Psychiatr Res 2002; 36(4): NICE (2011) Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. Management in primary, secondary and community care (NICE guideline). Clinical guideline 113. National Institute for Health and Care Excellence. Rickels K, Downing R, Schweizer E, et al. Antidepressants for the treatment of generalized anxiety disorder: a placebo-controlled comparison of imipramine, trazodone, and diazepam. Arch Gen Psychiatry 1993;50:
8 Rickels K, Pollack M H, Feltner D E, et al. Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebocontrolled trial of pregabalin and alprazolam. Arch Gen Psychiatry 2005;62: The Canadian journal of psychiatry. Clinical practice guidelines. Management of anxiety disorders. 2006; 51(suppl 2): 51-55s. 8
9 Appendix 1 Primary Care - Pharmacological management of generalised anxiety disorder Step 1 Step 2 Step 3 Step 4 Focus of the Intervention All known and suspected Presentations of GAD Diagnosed GAD that has not improved after education and active monitoring in primary care GAD with an inadequate response to step 2 interventions or marked function impairment Complex treatment-refractory GAD and very marked functional impairment, such as self neglect or a high risk of self harm Nature of the Intervention Identification assessment; education; active monitoring. Low intensity psychological interventions; self help, individual guided self help psycho educational groups High intensity psychological intervention (CBT/applied relaxation) Or drug treatment Refer to Specialist Does the patient meet the criteria for a diagnosis of depression? Is immediate pharmacological management necessary? Refer to the Depression Guidance Consider offering: Benzodiazepines do not use for more than 2-4 weeks Sedative antihistamines do not use for more than 4 weeks Pharmacological therapy Before prescribing, consider: age previous treatment response risks of deliberate self-harm or accidental overdose tolerability possible interactions with concomitant medications the patients preference cost Considerations when prescribing a) Offer an SSRI, unless otherwise indicated b) If one SSRI is not suitable or there is no improvement after a 12-week course (including dose titration to optimum dose, and a further medication is appropriate, another SSRI should be offered. c) Inform patients, at the time treatment is initiated, about: - potential side effects (including transient increase in anxiety at the start of treatment) - possible discontinuation/withdrawal symptoms. - delay in onset of effect - time course of treatment - need to take medication as prescribed (this may be particularly important with short half-life medication in order to avoid discontinuation/withdrawal symptoms) d) Written information appropriate for the patient s needs should be made available e) Side effects on initiation may be minimised by starting at a low dose and slowly increasing the dose until a satisfactory therapeutic response is achieved. Long-term treatment and doses at the upper end of the indicated dose range may be necessary ª Paroxetine and escitalopram has a licence for the treatment of generalised anxiety disorder Drug Dose First Line Sertraline initially 50 mg daily, increased after 1 week to 100mg daily; (Unlicensed) if response partial and drug tolerated, increased in steps of 50 mg at least weekly. Max 200 mg daily. Monitoring: Review efficacy and side effects within 2 weeks of starting treatment and again at 4,6 & 12 weeks Review at 8-12 week intervals if drug used for more than 12 weeks Follow Summary of Product Characteristics for all other monitoring required Use short, self-complete questionnaires to monitor outcomes wherever possible Citalopram Patients should be started on 10 mg/day and the dose gradually increased in 10 mg (Unlicensed) steps according to the patient's response up to the recommended dose. The recommended dose is mg daily. (Please monitor for QT prolongation in line with recommendations from the MHRA) Fluoxetine 20 mg each morning higher doses on specialist advice only. Paroxetine 20 mg each morning, higher doses on specialist advice only Has there been an improvement after 12 weeks of treatment? E Ongoing management Use with appropriate monitoring for 6 months after optimal dose reached: then dose can be tapered When stopping, reduce the dose gradually over an extended period Review Reassess the patient and consider trying another SSRI 9 Is this at least the second intervention tried? Review and offer referral to specialist mental health services if appropriate
10 Appendix 2 Specialist Pharmacological Treatment for Generalised Anxiety Disorder Ongoing management Use with appropriate monitoring for 6 months after optimal dose reached: then dose can be tapered When stopping, reduce the dose gradually over an extended period Review diagnosis, if depression is a prominent feature then treat according to depression guidance. Has the patient responded to prior treatment? Ensure that first and second line agents have been tried if suitable for an adequate period of time. If so, then switch to alternative agent. First line agents Sertraline, Citalopram, Fluoxetine and Paroxetine Second line agents Venlafaxine, Duloxetine Third Line agents (under specialist supervision - Pregabalin Fourth line agents (Specialist Only) Trazodone, Buspirone and Hydroxyzine Consider offering: 1a Duloxetine Venlafaxine Escitalopram Does the patient exhibit any depressive symptoms? Monitoring Review efficacy and side effects within 2 weeks of starting treatment and again at 4,6 and 12 weeks Review at 8-12 week intervals if drug used for more than 12 weeks Follow Summary of Product Characteristics for all other monitoring required Use short, self-complete questionnaires to monitor outcomes wherever possible - Consider offering: 1b Pregabalin* If using an agent from 1a consider use of an agent from 1b or under fourth line agents Has there been an improvement after 12 weeks of treatment? Ongoing management Use with appropriate monitoring for 6 months after optimal dose reached: Continue to review treatment. Pharmacotherapy should be used in conjunction with CBT where appropriate. Duloxetine should be offered in preference to trazadone due to greater likelihood of patient tolerability. If a patient fails to respond to treatment from 1a consideration should be given to treatment from 1b, or visa versa. If the patient fails to respond fully to either agent consideration should be given to augmentation therapy. # Buspirone should be used in preference to pregabalin due to greater long term data and lower acquisition cost. * Pregabalin should be used by Consultant Psychiatrists only and we would not routinely support its initiation by General Practitioners. Unlicensed Use: Atypical antipsychotics olanzapine and risperidone may be effective adjunctive agents for patients who are refractory to other therapies. However due to the risk of weight gain and metabolic side effects, their use should be reserved for treatment refractory cases. 10
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 informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
Step 3: GAD with marked functional impairment or that has not improved after step 2 interventionsentions bring together everything NICE says on a topic in an interactive flowchart. are interactive and
More informationVolume 4; Number 5 May 2010
Volume 4; Number 5 May 2010 CLINICAL GUIDELINES FOR ANTIDEPRESSANT USE IN PRIMARY AND SECONDARY CARE Lincolnshire Partnership Foundation Trust in conjunction with Lincolnshire PACEF have recently updated
More informationPharmacological treatment of anxiety disorders where is
Pharmacological treatment of anxiety disorders where is the room for improvement? David S Baldwin, Professor of Psychiatry BAP Masterclass, 15 th April 2011 dsb1@soton.ac.uk Declaration of interests (last
More informationforeword general general Six Persimmons 六柿圖 other modalities of treatments by evidence or impression? anxiety disorders drugs benzodiazepines
Clinical Updates Management of Anxiety Disorders John So - Psychiatrist foreword Six Persimmons 六柿圖 MuqiFachang 牧谿法常 after Zen meditation mindfulness other trends of psychotherapy other modalities of treatments
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Scope for Partial Update
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Scope for Partial Update 1 Guideline title Anxiety: management of generalised anxiety disorder in adults in primary, secondary and community care (update)
More informationMMG004 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 informationClinical Guideline / Formulary Document Pharmacy Department Medicines Management Services
Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services ANXIETY DISORDERS This guideline covers a range of anxiety disorders, including generalised anxiety disorder, social
More informationThe pharmacological management of anxiety disorders
Stephen Bleakley MRPharmS, MCMHP Review in association with The pharmacological management of anxiety disorders Progress in Neurology and Psychiatry is running a series of articles on the major psychiatric
More informationPregabalin Prescribing in Primary Care Audit Results 2012/13
Executive summary Pregabalin Prescribing in Primary Care Audit Results 2012/13 Pregabalin is extensively used across Aneurin Bevan Health Board (ABHB). It is the second highest medicine in terms of primary
More informationPregnancy. General Principles of Prescribing in Pregnancy (The Maudsley, 12 th Edition)
Pregnancy General Principles of Prescribing in Pregnancy (The Maudsley, 12 th Edition) In all women of child bearing potential Always discuss the possibility of pregnancy; half of all pregnancies are unplanned
More informationMedication management of anxiety & depression. Dr Katie Simpson GP Mental health lead East Berks CCG
Medication management of anxiety & depression Dr Katie impson GP Mental health lead East Berks CCG NICE guidelines for Anxiety tepped Care RIs and NRIs in Anxiety disorders RI ertraline Citalopram Fluoxetine
More informationAnxiety Disorders: First aid and when to refer on
Anxiety Disorders: First aid and when to refer on Presenter: Dr Roger Singh, Consultant Psychiatrist, ABT service, Hillingdon Educational resources from NICE, 2011 NICE clinical guideline 113 What is anxiety?
More informationDocument Title Antipsychotics Prescribing Guidelines for Schizophrenia
Document Title Antipsychotics Prescribing Guidelines for Schizophrenia Document Description Document Type Prescribing Guidance Service Application Medicines Management Version 1.0 Policy Reference no.
More informationRecommendation 1: Diagnosis of Generalized Anxiety Disorder (IΙΙ-2)
Final GAD RECOMMENDATIONS & EVIDENCE Recommendation 1: Diagnosis of Generalized Anxiety Disorder (IΙΙ-2) It is recommended for general practitioners and other Primary Health Care doctors to consider the
More informationPSYCHIATRIC 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 informationGuidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 3 October 2014)
Guidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 3 October 2014) Date of Preparation: September 2014 Date for next full
More informationPROCEDURE REF NO SABP/EXECUTIVE BOARD/0017
PROCEDURE REF NO SABP/EXECUTIVE BOARD/0017 NAME OF GUIDELINE REASON FOR GUIDELINE WHAT THE GUIDELINE WILL ACHIEVE? WHO NEEDS TO KNOW ABOUT IT? Medicines Guideline: Hypnotic Medication Compliance with NICE
More informationPresenter Disclosure. Objectives 6/5/2017. Depression, Anxiety, PTSD: A Focus on Pharmacotherapy
Depression, Anxiety, PTSD: A Focus on Pharmacotherapy Robert L Page II, Pharm.D., MSPH, FHFSA, FCCP, FAHA Professor of Clinical Pharmacy Clinical Specialist, Division of Cardiology University of Colorado
More informationMedication for Anxiety and Depression. PJ Cowen Department of Psychiatry, University of Oxford
Medication for Anxiety and Depression PJ Cowen Department of Psychiatry, University of Oxford Topics Medication for anxiety disorders Medication for first line depression treatment Medication for resistant
More informationAmendments to recommendations concerning venlafaxine
Amendments to recommendations concerning venlafaxine On 31 May 2006 the MHRA issued revised prescribing advice for venlafaxine*. This amendment brings the guideline into line with the new advice but does
More informationDepression 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 informationSHARED CARE GUIDELINE
SHARED CARE GUIDELINE Title: Shared Care Guideline for the prescribing and monitoring of Antipsychotics for the treatment of Schizophrenia and psychotic symptoms in children and adolescents Scope: Pennine
More informationManagement of generalised anxiety disorder
Psychiatry 505 Management of generalised anxiety disorder Generalised anxiety disorder is common and can present in older people, often in conjunction with depressive symptoms. Pharmacological treatments
More informationGuidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 4.
Guidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 4.1 December 2018) Date of Preparation: January 2018 (with addition of
More informationGREATER MANCHESTER INTERFACE PRESCRIBING GROUP
GREATER MANCHESTER INTERFACE PRESCRIBING GROUP On behalf of the GREATER MANCHESTER MEDICINES MANAGEMENT GROUP SHARED CARE GUIDELINE FOR THE PRESCRIBING OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
More informationReducing 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 informationPanic 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 informationClinical. High Dose Antipsychotic Prescribing Procedures. Document Control Summary. Contents
Clinical High Dose Antipsychotic Prescribing Procedures Document Control Summary Status: Version: Author/Owner/Title: Approved by: Ratified: Related Trust Strategy and/or Strategic Aims Implementation
More informationANXIETY: FAST FACTS AND SKILLS FOR THE PRIMARY CARE PHYSICIAN
UW PACC Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences ANXIETY: FAST FACTS AND SKILLS FOR THE PRIMARY CARE PHYSICIAN RYAN KIMMEL, MD MEDICAL DIRECTOR HOSPITAL
More informationEffective Date: 5/28/2014 Version: 2.0 (Revised: 10/12/2015) Approval By: CCC Clinical Delivery Steering Planned Review Date: (04/47/2017)
Protocol Title: Depression & Generalized Anxiety Disorder Effective Date: 5/28/2014 Version: 2.0 (Revised: 10/12/2015) Approval By: CCC Clinical Delivery Steering Planned Review Date: (04/47/2017) Group
More informationNeuropathic pain MID ESSEX LOCALITY
Neuropathic pain Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system. A. Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) i Read questions to
More informationDepression: management of depression in primary and secondary care
Issue date: December 2004, with amendments April 2007 Quick reference guide (amended) Depression: management of depression in primary and secondary care Amendment of recommendations concerning venlafaxine:
More informationQuick Guide to Common Antidepressants-Adults
Quick Guide to Common Antidepressants-Adults Medication Therapeutic Range (mg/day) Initial Suggested Serotonin Reuptake Inhibitors (SSRIs) All available as generic FLUOXETINE (Prozac) CITALOPRAM (Celexa
More informationHigh Dose Antipsychotic Therapy (HDAT) guideline
Document level: Trustwide (TW) Code: MP18 Issue number: 2 High Dose Antipsychotic Therapy (HDAT) guideline Lead executive Medical Director Author and contact number Lead Clinical Pharmacist 01625 663 857
More informationMERSEY CARE NHS TRUST HOW WE MANAGE MEDICINES. MM11 - High-Dose Antipsychotic Use Guidelines (local guideline) KEY ISSUES
MERSEY CARE NHS TRUST HOW WE MANAGE MEDICINES MM11 - High-Dose Antipsychotic Use Guidelines (local guideline) Medicines Management Services aim to ensure that (i) Service users receive their medicines
More informationSHARED CARE GUIDELINE
SHARED CARE GUIDELINE Shared Care Guideline for the prescribing and monitoring of antipsychotics for the treatment of Neurodevelopmental Disorders in children and adolescents. Scope: Version 1 Pennine
More informationMMG003 GUIDELINES FOR THE USE OF HYPNOTICS FOR THE TREATMENT OF INSOMNIA
MMG003 GUIDELINES FOR THE USE OF HYPNOTICS FOR THE TREATMENT OF INSOMNIA Page 1 of 11 Table of Contents Why we need this Guideline... 3 What the Policy is trying to do... 3 Which stakeholders have been
More informationPharmacological Treatment of Anxiety & Depressive Disorders
Pharmacological Treatment of Anxiety & Depressive Disorders Dr Gary Jackson (MB BCh FRCPsych) Consultant Psychiatrist The Priory Hospital Chelmsford Wellesley Hospital Southend-on-Sea Medical Secretary:
More informationChildren s Hospital Of Wisconsin
Children s Hospital Of Wisconsin Co-Management Guidelines To support collaborative care, we have developed guidelines for our community providers to utilize when referring to, and managing patients with,
More informationClinical guideline Published: 28 October 2009 nice.org.uk/guidance/cg90
Depression in adults: recognition and management Clinical guideline Published: 28 October 2009 nice.org.uk/guidance/cg90 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationAntidepressants (Tricyclic Antidepressants, Selective Serotonin Reuptake Inhibitors) in children 6-12 years of age with depressive episode/disorder
updated 2012 Antidepressants (Tricyclic Antidepressants, Selective Serotonin Reuptake Inhibitors) in children 6-12 years of age with depressive episode/disorder Q10: Are antidepressants (Tricyclic antidepressants
More informationClinical Guideline / Formulary Document Pharmacy Department Medicines Management Services
Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services DEPRESSION Pharmacological Treatment of Depression NICE guidelines suggest the following stepped care model also
More informationClinical guideline Published: 28 October 2009 nice.org.uk/guidance/cg90
Depression in adults: recognition and management Clinical guideline Published: 28 October 2009 nice.org.uk/guidance/cg90 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationGuidelines on Choice and Selection of Antidepressants for the Management of Depression
Working in partnership: Hertfordshire Partnership University NHS Foundation Trust East and North Hertfordshire Clinical Commissioning Group Herts Valleys Clinical Commissioning Group Guidelines on Choice
More informationCritical Care Pharmacological Management of Delirium
Critical Care Pharmacological Management of Delirium Policy Title: in the Critical Care Unit Executive Summary: This policy provides guidance Pharmacological Management of delirium in the Critical Care
More informationIs 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 informationPsychiatry 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 informationCase #1. Case #1. Case #1. Discussion. DSM IV Overview of PD. Psychopharmacology of Panic Disorder and Generalized Anxiety Disorder 09/03/2012
Case #1 Psychopharmacology of Panic Disorder and Generalized Anxiety Disorder Smit S. Sinha MD Assistant Professor A 33 year old male engineer presents to an outpatient clinic for consultation for severe
More informationGuidelines on Choice and Selection of Antidepressants for the Management of Depression
Guidelines on Choice and Selection of Antidepressants for the Management of Depression 1. Introduction This guidance should be considered as part of a stepped care approach in the management of depressive
More informationScottish Medicines Consortium
Scottish Medicines Consortium escitalopram, 5mg, 10mg, and 20mg tablets and 10mg/ml oral drops (Cipralex) No. (406/07) Lundbeck Ltd 7 September 2007 The Scottish Medicines Consortium has completed its
More informationManaging Behavioural Problems in Patients with Learning Disabilities
Managing Behavioural Problems in Patients with Learning Disabilities Some people with a learning disability display behaviour that challenges. Although such behaviour is a challenge to services, family
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Drug Misuse: opiate detoxification of drug misusers in the community, hospital and prison. 1.1 Short title Drug misuse detoxification
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Neuropathic pain pharmacological management: the pharmacological management of neuropathic pain in adults in non-specialist
More informationfor anxious and avoidant behaviors.
Summary of the Literature on the Treatment of Anxiety Disorders in Children and Adolescents Sucheta D. Connolly, M.D.* Non-OCD anxiety disorders in youth are common and disabling, with 12-month prevalence
More informationGuidance on Consent to Treatment Documentation for Medication Patient s Detained under the Mental Health Act
Guidance on Consent to Treatment Documentation for Medication Patient s Detained under the Mental Health Act This guidance is intended for Coventry and Warwickshire Partnership Trust staff to use when
More informationSHARED CARE GUIDELINE
SHARED CARE GUIDELINE Shared Care Guideline for the treatment of Tourette s Syndrome and other tic disorders in children and adolescents. Scope: Version: Pennine Care NHS Foundation Trust NHS Bury NHS
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Centre for Clinical Practice Surveillance Programme
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Centre for Clinical Practice Surveillance Programme Clinical guideline CG28: Depression in children and young people: identification and management in
More informationDRAFT. Consultees are asked to consider and comment on the CEPP National Audit: Antipsychotics in Dementia document.
Enclosure No: Agenda item No: Author: Contact: xx/xxxxx/xxxx0918 xx CEPP National Audit: Antipsychotics in Dementia All Wales Therapeutics and Toxicology Centre Tel: 02920 71 6900 awttc@wales.nhs.uk 1.0
More informationIs 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 informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE. Opinion. 1 October 2008
The legally binding text is the original French version TRANSPARENCY COMMITTEE Opinion 1 October 2008 EFFEXOR SR 37.5 mg prolonged-release capsule B/30 (CIP: 346 563-3) EFFEXOR SR 75 mg prolonged-release
More informationPsychopharmacology. 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 informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Drug Misuse: opiate detoxification of drug misusers in the community, hospital and prison. 1.1 Short title Drug misuse detoxification
More informationFormulary and Prescribing Guidelines
Formulary and Prescribing Guidelines SECTION 3: TREATMENT OF BIPOLAR AFFECTIVE DISORDER This section provides information regarding the pharmacological management of Bipolar affective disorder in secondary
More informationKEY 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 informationFirst-Line Pharmacotherapy Approaches for Generalized Anxiety Disorder. Jonathan R. T. Davidson, MD
First-Line Pharmacotherapy Approaches for Generalized Anxiety Disorder Jonathan R. T. Davidson, MD Many patients with generalized anxiety disorder (GAD) do not receive adequate treatment. Several classes
More informationGuidance on Safe Prescribing of Melatonin for Sleep Disorders in Children, Young People and Adults
Guidance on Safe Prescribing of Melatonin for Sleep Disorders in Children, Young People and Adults Ref: PHARM-0025-v3 Status: FINAL Document type: Guidelines Guidance on Safe Prescribing of Melatonin Page
More informationClinical 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 informationCritical Care Pharmacological Management of Delirium
Critical Care Pharmacological Management of Delirium Policy Title: in the Critical Care Unit Executive Summary: This policy provides guidance Pharmacological Management of delirium in the Critical Care
More informationTITLE: Buspirone for the Treatment of Anxiety: A Review of Clinical Effectiveness, Safety, and Cost-Effectiveness
TITLE: Buspirone for the Treatment of Anxiety: A Review of Clinical Effectiveness, Safety, and Cost-Effectiveness DATE: 03 May 2012 CONTEXT AND POLICY ISSUES Generalized Anxiety Disorder (GAD) is a chronic
More informationAdult Neurodevelopmental Services. ADHD Shared Protocol
Adult Neurodevelopmental Services ADHD Shared Protocol Issue 1: April 2016 1 2 Adult Neurodevelopmental Service Shared Care Protocol for Adult Attention Deficit Hyperactivity Disorder (ADHD) 1. BACKGROUND
More informationSiGMA/ MMHSCT GUIDELINES FOR ANTIPSYCHOTIC DRUG TREATMENT OF SCHIZOPHRENIA. [compatible with NICE guidance]
SiGMA/ MMHSCT GUIDELINES FOR ANTIPSYCHOTIC DRUG TREATMENT OF SCHIZOPHRENIA [compatible with NICE guidance] Medicines Management Committee August 2002 For review August 2003 Rationale The SiGMA algorithm
More informationDepression in children: identification and management of depression in children and young people in primary, community and secondary care
Depression in children: identification and management of depression in children and young people in primary, community and secondary care NICE guideline First consultation, November 2004 If you wish to
More informationPRACTICAL 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 informationIPAP PTSD Algorithm -- Addenda
www.ipap.org/ptsd General Principles IPAP PTSD Algorithm -- Addenda I. Initial and repeated evaluations A. PTSD is common and often goes undiagnosed. Given the high prevalence of exposure to trauma (including
More informationANXIETY DISORDERS IN THE ELDERLY IMPACT OF LATE-LIFE ANXIETY CHANGES IN DSM-5 THE COSTS 6/4/2015 LATE-LIFE ANXIETY TOPICS TO BE COVERED
LATE-LIFE ANXIETY TOPICS TO BE COVERED ANXIETY DISORDERS IN THE ELDERLY Dr. Lisa Talbert Classes of Anxiety Disorders Diagnosis Comorbidities Pharmacologic Management Psychological Management LATE LIFE
More informationNeuropathic Pain Treatment Guidelines
Neuropathic Pain Treatment Guidelines Background Pain is an unpleasant sensory and emotional experience that can have a significant impact on a person s quality of life, general health, psychological health,
More informationHow to Manage Anxiety
How to Manage Anxiety Dr Tony Fernando Psychological Medicine University of Auckland Auckland District Health Board www.insomniaspecialist.co.nz www.calm.auckland.ac.nz Topics How to diagnose How to manage
More informationBenzodiazepines and Hypnotics
Benzodiazepines and Hypnotics Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience, state if Trust wide): Review date (when this version goes out of date):
More informationPsychotropic Drug Therapy in Adults with Learning Disability. Steve Wilkinson
Psychotropic Drug Therapy in Adults with Learning Disability Steve Wilkinson Outline and Aims of the Session Drug use in learning disability Two distinct areas of drug therapy I. Treatment of common psychiatric
More informationCosts: description and values Outcomes: description and values. Costs: Consultations with psychologists, psychiatrists, GPs
Appendix 16f: Evidence tables for economic studies High intensity psychological interventions for Generalised Anxiety Disorder Reference to included study Heuzenroeder L, Donnelly M, Haby MM, Mihalopoulos
More informationAlcohol Detoxification (Inpatient) Prescribing Guidelines
Alcohol Detoxification (Inpatient) Prescribing Guidelines Author: Sponsor/Executive: Responsible committee: Consultation & Approval: (Committee/Groups which signed off the procedure, including date) This
More informationConduct Disorder in Children and Young People (CYP 5-18 years of age) RISPERIDONE Effective Shared Care Agreement (ESCA)
E102 Conduct Disorder in Children and Young People (CYP 5-18 years of age) RISPERIDONE Effective Shared Care Agreement (ESCA) Patient details Name: Date of birth: NHS number: Contact details Specialist:
More informationMajor Depressive Disorder (MDD) in Children under Age 6
in Children under Age 6 Level 0 Comprehensive assessment. Refer to Principles of Practice on page 6. Level 1 Psychotherapeutic intervention (e.g., dyadic therapy) for 6 to 9 months; assessment of parent/guardian
More informationPHYSICIAN REFERENCE ANTIDEPRESSANT DOSING GUIDELINES
PHYSICIAN REFERENCE ANTIDEPRESSANT DOSING GUIDELINES Table of Contents Print TABLE OF CONTENTS Drug Page Number Anafranil... 2 Asendin... 4 Celexa... 4 Cymbalta... 6 Desyrel... 8 Effexor...10 Elavil...14
More informationAripiprazole Long-Acting Injection (Abilify Maintena ) Guidelines for Prescribing and Administration (Version 3 August 2014)
1. Key Points. Aripiprazole Long-Acting Injection (Abilify Maintena ) Guidelines for Prescribing and Administration (Version 3 August 2014) 1.1 Aripiprazole long acting injection (LAI) is licensed / indicated
More informationPerinatal Mental Health: Prescribing Guidance for Trust Prescribers and GPs
Perinatal Mental Health: Prescribing Guidance for Trust Prescribers and GPs (Version 3 January 2015) Principal Author: Dr Jenny Cooke Consultant Psychiatrist, Brighton & Hove Perinatal Mental Health Service
More informationAppendix C - Summary form
National Institute for Health and Clinical Excellence Appendix C - Summary form Single Techn Appraisal (STA) Agomelatine for the treatment of major depressive episodes Response to consultee and commentator
More informationAdverse events of common psychiatric medications: an umbrella review
Adverse events of common psychiatric medications: an umbrella review Katrina Bartellas, 1 Thomas Bajorek 1 Sarah Stockton, 1 Stefan Leucht, 2 Andrea Cipriani, 1 Seena Fazel 1 1 Department of Psychiatry,
More informationBenzodiazepines: risks, benefits or dependence
Benzodiazepines: risks, benefits or dependence A re-evaluation Council Report CR 59 January 1997 Royal College of Psychiatrists, London Due for review: January 2002 1 Contents A College Statement 3 Benefits
More informationGENERALIZED ANXIETY DISORDER (GAD) PRACTICE PRINCIPLE FOR PRIMARY CARE: ADULTS 18 AND OLDER
Practice Guidelines and Principles: Guidelines and principles are intended to be flexible. They serve as reference points or recommendations, not rigid criteria. Guidelines and principles should be followed
More informationPresentation 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 informationStart Low, Go Slow but Treat to Target
Start Low, Go Slow but Treat to Target Pharmacotherapy for Depression, Anxiety and At-Risk Alcohol Use in Late Life September 29, 2014 Audio and Control Panel instruction On the phone? Raise your hand
More informationMedication Management. Dr Ajith Weeraman MBBS, MD (Psychiatry), FRANZCP Consultant Psychiatrist Epworth Clinic Camberwell 14 th March 2015
Medication Management Dr Ajith Weeraman MBBS, MD (Psychiatry), FRANZCP Consultant Psychiatrist Epworth Clinic Camberwell 14 th March 2015 1 Medication Management Objectives: 1. Principles of psycho-pharmacology
More informationEligible Beneficiaries
Therapeutic Class: Behavioral Health Medications for Adults Clinical Edit Number Long Description 4110 (May change) Quantity limit edit that is applied to atypical antipsychotics for claims identified
More informationMajor Depression and Anxiety in Adolescents and Adults
Major Depression and Anxiety in Adolescents and Adults Miggie Greenberg, M.D. Associate Professor of Psychiatry St. Louis University School of Medicine greenbml@slu.edu *NO DISCLOSURES* OBJECTIVES * Recognize
More informationPharmacological Strategies for Generalized Anxiety Disorder
January 30, 2015 By Jennifer A. Reinhold, PharmD, BCPS, BCPP [1] Treatment approaches to GAD, a highly prevalent, chronic, debilitating, relapsing, and often underdiagnosed anxiety disorder. Generalized
More informationClinical guideline Published: 28 October 2009 nice.org.uk/guidance/cg91
Depression in adults with a chronic physical health problem: recognition and management Clinical guideline Published: 28 October 2009 nice.org.uk/guidance/cg91 NICE 2018. All rights reserved. Subject to
More informationPALIPERIDONE LONG ACTING INJECTION PRESCRIBING GUIDELINE. Chief Pharmacist. Chief Pharmacist
REFERENCE NUMBER: PALIPERIDONE LONG ACTING INJECTION PRESCRIBING GUIDELINE AREA: NAME OF RESPONSIBLE COMMITTEE / INDIVIDUAL NAME OF ORIGINATOR / AUTHOR Trust-wide Chief Pharmacist Chief Pharmacist DATE
More information