By vgreene, 13 October, 2020 Monitor at least monthly after tx start change until remission ie 2mo w o sx 4 Once in remission continue drug therapeutic dose 6mo to darr relapse risk 3 ICSI recommends 4 9mo once remission achieved ie 6 12mo total MDD relapses recurrences occur in 50 8
By vgreene, 13 October, 2020 Counsel advise Caution pts to watch closely for worsening depression unusual behavior esp in 1st few wks of drug start or dose change
By vgreene, 13 October, 2020 If neither psychotherapy nor drug acceptable consider bright light tx 2 3 St John s wort 2 exercise 1 2 bibliotherapy 3 non directive supportive tx or psychodynamic tx3
By vgreene, 13 October, 2020 <b>Monitor</b> at least monthly after tx start/change until remission (ie, 2mo w/o sx)<sup>ICSI</sup>
By vgreene, 13 October, 2020 If combining therapy w other tx APA recommends interpersonal therapy SGA in older adults vs interpersonal therapy alone APA cautions against use of nortriptyline in older adults2
By vgreene, 13 October, 2020 Monitor at least monthly after tx start change until remission ie 2mo w o sx 4 Once in remission continue drug therapeutic dose 6mo to darr relapse risk 3 ICSI recommends 4 9mo after remission achieved ie 6 12mo total MDD relapses recurrences occur in 50
By vgreene, 13 October, 2020 Counsel advise Caution pts to watch closely for worsening depression unusual behavior esp in 1st few wks of drug start or dose change
By vgreene, 13 October, 2020 TCAs Avoid tertiary amine TCAs d to uarr incidence of orthostatic hypotension sedation cognitive problems cardiac effects 4 APA specifically recommends avoiding nortriptyline in older adults2
By vgreene, 13 October, 2020 If neither psychotherapy nor drug acceptable consider bright light tx St John s wort 2 3 exercise 1 2 bibliotherapy 3 non directive supportive tx or psychodynamic tx3
By vgreene, 13 October, 2020 Consider factors safety side effect profile eg constipation diarrhea nausea dizziness insomnia somnolence sexual dysfxn 1 uarr risk of upper GI bleeding esp w SSRIs in adults 70 yo w risk uarr w age5 med list drug interactions cost feasibility pt specific
