Presentation is loading. Please wait.

Presentation is loading. Please wait.

Treating Depression in the Primary Care Setting Pharmacologic Interventions Presented by: Jonathan Betlinski, MD Date: 09/25/2014.

Published byIsabel Wilkins Modified over 9 years ago

Similar presentations

Presentation on theme: "Treating Depression in the Primary Care Setting Pharmacologic Interventions Presented by: Jonathan Betlinski, MD Date: 09/25/2014."— Presentation transcript:

1 Treating Depression in the Primary Care Setting Pharmacologic Interventions Presented by: Jonathan Betlinski, MD Date: 09/25/2014

2 Disclosures and Learning Objectives Learning Objectives – Describe the Acute, Continuation and Maintenance phases of MDD treatment – Know 3 ways to augment antidepressants – Know 5 ways to address non-response Disclosures: Dr. Jonathan Betlinski has nothing to disclose.

3 Depression in the Primary Care Setting Quick review of Screening for Depression Quick review of Nonpharmacology Pharmacological Treatment of Depression – Acute Phase – Continuation Phase – Nonresponse – Maintenance Phase Next Week's Topic

4 SIG E CAPS for Depression Ssleep decreased (or increased) Iinterest decreased Gguilt or worthlessness Eenergy decreased Cconcentration difficulties Aappetite disturbance or weight loss Ppsychomotor agitation or retardation Ssuicidal thoughts and depressed mood!

5 Treatment of Depression in Primary Care Start all treatment with a medical work up http://www.nimh.nih.gov/health/publications/depression/index.shtml#pub6 Next comes Sleep Hygiene www.cci.health.wa.gov.au/docs/Info-sleep%20hygiene.pdf And Exercise http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/pdf/nihms-386053.pdf And Behavioral Activation www.personal.kent.edu/~dfresco/CBT_Readings/BM_Lejuez_BATD_Manual.pdf Antidepressants are no better than placebo for mild to moderate depression http://medicine.plosjournals.org/archive/1549-1676/5/2/pdf/10.1371_journal.pmed.0050045-L.pdf

6 Pharmacology – Acute Phase Choose antidepressant based on – Prior response (individual or family) – Patient preference – Side effect profile – Safety in overdose – Availability and costs – Drug-Drug interactions – Impacts on co-morbid conditions https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

7 Pharmacology – Acute Phase – Initial Most AD's are comparably effective SSRI: citalopram, sertraline, fluoxetine, escitalopram SNRI: venlafaxine, duloxetine, desvenlafaxine, Mirtazapine (sedation, weight gain) Bupropion (weight loss, nicotine cravings) http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

8 Pharmacology – Acute Phase – Next Titrate to an effective dose Goal is a PHQ-9 of less than 5 Response may take 4-8 weeks If side effects are too much, try lowering the dose or switching. Save MAOIs and TCAs for second line http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

9 Pharmacology – Nonresponse Reappraise diagnosis Assess side effects Assess comorbid conditions Review psychosocial factors Check treatment adherence Check on psychotherapy progress Consider medication switch vs. augment http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

10 Pharmacology – Nonresponse - Changing Switch to another AD from same class Switch to an AD from a different class – Try an SNRI when SSRI not effective Augment with a different class AD – Augment with T3 – Augment with lithium – Augment with a second-generation antipsychotic http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

11 Pharmacology – Continuation Phase Continue Acute Phase treatment For 4-9 months Monitor regularly for recurrence Use depression-focused psychotherapy to help prevent relapse (CBT)

12 Pharmacology – Maintenance Phase Continue full therapeutic dose Continue antidepressants indefinitely For a complicated 2 nd episode For a third episode For chronic depression http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6 Monitor with PHQ-9 or WHO-DAS http://www.who.int/entity/classifications/icf/WHODAS2.0_36itemsSELF.pdf?ua=1

13 Treating Depression in Primary Care Depression is both common and treatable PHQ-9 simplifies detecting and quantifying depression--and monitoring, too The first steps in the treatment of recovery are usually nonpharmacological Appropriate medications can be helpful Treat to remission

14 The End! Next Week's Topic: Assessing Suicide Risk

Download ppt "Treating Depression in the Primary Care Setting Pharmacologic Interventions Presented by: Jonathan Betlinski, MD Date: 09/25/2014."

Similar presentations

Depression in adults with a chronic physical health problem

Depression in adults with a chronic physical health problem
Depression Lawrence Pike.

Depression Lawrence Pike.
DEPRESSION and ANXIETY

DEPRESSION and ANXIETY
Pharmacologic Treatments. 2 Cognitive Behavioural Therapy (CBT) Psychosocial Interventions.

Pharmacologic Treatments. 2 Cognitive Behavioural Therapy (CBT) Psychosocial Interventions.
Depression & Antidepressants Fareed Bhatti Pennine VTS - November 2009.

Depression & Antidepressants Fareed Bhatti Pennine VTS - November 2009.
Guy Brookes Leeds PFT.  Antipsychotic Medication  Antidepressant Medication  Mood Stabilisers  What does the Evidence mean?

Guy Brookes Leeds PFT.  Antipsychotic Medication  Antidepressant Medication  Mood Stabilisers  What does the Evidence mean?
2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut1 Bipolar Disorder An Update Presented by Dr Ismail Habli Moderator: Dr Elio Sassine.

2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut1 Bipolar Disorder An Update Presented by Dr Ismail Habli Moderator: Dr Elio Sassine.
Initiate therapy with SSRI - ! fluoxetine 20 mg (10 -80 mg) or citalopram 20 mg (10 -60 mg) Exercise, Pt education: response expectations, followup ~ 1.

Initiate therapy with SSRI - ! fluoxetine 20 mg ( mg) or citalopram 20 mg ( mg) Exercise, Pt education: response expectations, followup ~ 1.
GENERALIZED ANXIETY DISORDER IN PRIMARY CARE Curley Bonds, MD Medical Director Didi Hirsch Mental Health Services Professor & Chair Charles R. Drew University.

GENERALIZED ANXIETY DISORDER IN PRIMARY CARE Curley Bonds, MD Medical Director Didi Hirsch Mental Health Services Professor & Chair Charles R. Drew University.
Depression Alison Turner-Parry Sam Rosenburg. Aims  To have an enjoyable time covering elements of the GP mental health curriculum.

Depression Alison Turner-Parry Sam Rosenburg. Aims  To have an enjoyable time covering elements of the GP mental health curriculum.
Intro to Psychopharmacology Caitlin Stork, MD. Besides dopamine blockade... ReceptorEffect of Blockade Acetylcholine (muscarinic; M1) Anticholinergic.

Intro to Psychopharmacology Caitlin Stork, MD. Besides dopamine blockade... ReceptorEffect of Blockade Acetylcholine (muscarinic; M1) Anticholinergic.
EPECEPECEPECEPEC EPECEPECEPECEPEC Depression, Anxiety, Delirium Depression, Anxiety, Delirium Module 6 The Project to Educate Physicians on End-of-life.

EPECEPECEPECEPEC EPECEPECEPECEPEC Depression, Anxiety, Delirium Depression, Anxiety, Delirium Module 6 The Project to Educate Physicians on End-of-life.
Treating Bipolar Disorder in the Primary Care Setting

Treating Bipolar Disorder in the Primary Care Setting
Assessing Bipolar Disorder in the Primary Care Setting

Assessing Bipolar Disorder in the Primary Care Setting
Claudia L. Reardon, MD Assistant Professor University of Wisconsin School of Medicine and Public Health NAMI Wisconsin Annual Meeting April 24, 2015.

Claudia L. Reardon, MD Assistant Professor University of Wisconsin School of Medicine and Public Health NAMI Wisconsin Annual Meeting April 24, 2015.
Dr Maryam Naeem GPST2 Psychiatry

Dr Maryam Naeem GPST2 Psychiatry
2007. Statistics  2-4 new cases per 100,000/year  1 in 200 people will have an episode of hypomania  Peak age of onset 25-30 yrs  May have had a previous.

2007. Statistics  2-4 new cases per 100,000/year  1 in 200 people will have an episode of hypomania  Peak age of onset yrs  May have had a previous.
Depression Ibrahim Sales, Pharm.D. Associate Professor of Clinical Pharmacy King Saud University

Depression Ibrahim Sales, Pharm.D. Associate Professor of Clinical Pharmacy King Saud University
K.E..Badoe MBChB., FRCPC Medical Director, Trellis Mental Health and Developmental Services, Guelph MEDICAL FIESTA August 9 th 2012.

K.E..Badoe MBChB., FRCPC Medical Director, Trellis Mental Health and Developmental Services, Guelph MEDICAL FIESTA August 9 th 2012.
National Institute for Health and Clinical Excellence (NICE) Clinical Guideline on Depression & Anxiety  We understand how much of GP’s time is spent.

National Institute for Health and Clinical Excellence (NICE) Clinical Guideline on Depression & Anxiety  We understand how much of GP’s time is spent.

Similar presentations

Ads by Google