By vgreene, 5 October, 2020 If partial or no response to initial tx1 after 4 6wk tx2 eval for specialty mental health care 2 If pt doesn t need specialty mental health care either switch to a different single tx either a drug or psychotherapy regardless of initial tx 1 2 or augment
By vgreene, 4 October, 2020 Monitor pts at least monthly after tx start/change until remission; measure sx, adherence to med/psychotherapy, & adverse effects; consider these specific pt scenarios:
By vgreene, 4 October, 2020 If pt @ high risk for relapse (2+ prior episodes, unstable remission status): Offer CBT, IPT, or MBCT during continuation phase of tx (after remission achieved) to reduce risk of subsequent relapse/recurrence, per VAVA
By vgreene, 4 October, 2020 If pt on antidepressant @ high-risk for recurrence: Offer maintenance pharma-co tx for at least 12mo and possibly indefinitely, per VAVA
By vgreene, 4 October, 2020 If pt in remission (PHQ-9 ≤4 x1 mo), and on antidepressants: Offer any of 3 psychotherapies (CBT, MCBT, or IPT) vs antidepressant med or tx as usual to prevent relapse, per APA; in contrast, VA says continue antidepressants at the therapeutic dose for at
By vgreene, 4 October, 2020 If HIV: Consider coping improvement (group) vs psychotherapy on request (individual) for older adults w/ severe depressive sx, per APAAPA
By vgreene, 4 October, 2020 If temporarily homebound African American adults: Suggest multicomponent intervention (individual) to treat depressive sx, per APAAPA
