By vgreene, 13 October, 2020 Options SSRIs citalopram escitalopram paroxetine sertraline 1 3 but not fluvoxamine fluoxetine per VA 3 SNRIs start low dose 1 3 duloxetine venlafaxine desvenlafaxine levomilnacipran Atypical antidepressants bupropion mirtazapine 1 3 nefazodone 1 trazodon
By vgreene, 13 October, 2020 1st line evidence based options acceptance commitment therapy behavioral therapy behavioral activation cognitive behavioral therapy cognitive therapy interpersonal therapy mindfulness based cognitive therapy problem solving therapy 1 3 short term psychody
By vgreene, 13 October, 2020 If choosing psychotherapy pt preference guides individual vs group model 3
By vgreene, 12 October, 2020 <b>Monitor</b> at least monthly after tx start/change until remission (ie, 2mo w/o sx)<sup>ICSI</sup>
By vgreene, 12 October, 2020 If combining therapy w other tx APA recommends CBT interpersonal therapy SGA2
By vgreene, 12 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, 12 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 young adults
By vgreene, 12 October, 2020 Consider factors safety side effect profile eg constipation diarrhea nausea dizziness insomnia somnolence sexual dysfxn med list drug interactions cost feasibility pt specific sx insomnia hypersomnia fluctuation in appetite 1 anticholinergic effect availa
By vgreene, 12 October, 2020 Options SSRIs citalopram escitalopram fluoxetine paroxetine sertraline 1 3 but not fluvoxamine per VA 3 SNRIs start low dose 1 3 duloxetine venlafaxine desvenlafaxine levomilnacipran Atypical antidepressants bupropion mirtazapine 1 3 nefazodone 1 trazodon
By vgreene, 12 October, 2020 If choosing drug as initial tx offer 1st line options SSRI SNRI 1 3 some groups incl bupropion mirtazapine 1 3 nefazodone 1 trazodone vilazodone vortioxetine 1 3 VA DoD does not recommend nefazodone as 1st line tx because it s assoc w uarr risk of hospita
