By vgreene, 4 October, 2020 If T2DM/COPD: Consider combo of CBT (individual) + usual care, per APAAPA
By vgreene, 4 October, 2020 If pt unwilling/unable to engage in 1st-line psychotherapy or pharma-co tx: Consider exercise as monotherapy & bibliotherapy as alternative;ADD SOURCE offer supportive tx (non-directive) or psychodynamic txVA
By vgreene, 4 October, 2020 If pt (not on SSRI/clopidogrel) prefers herbal tx to 1st-line psychotherapy/pharma-co tx: Offer standardized extract of St. John’s wort monotherapy hypericin (0.1%-0.3% or hyperforin (1%-6%), therapeutic dose 500-1800 mg daily. In combo with SSRIs ↑r
By vgreene, 4 October, 2020 If seasonal pattern: Offer light tx (6,000-lux to 10,000-Lux light box x30-60 min/day) as initial mono-tx, per VA, APAVA,APA
By vgreene, 4 October, 2020 If significant relationship distress: Offer problem-focused couples' therapy, either as mono-tx OR in combo w/ pharmaco-tx, per VA;VA suggest BT vs antidepressant med alone;APA suggest CT + antidepressant to improve likelihood of full recovery (if conside
By vgreene, 4 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
By vgreene, 4 October, 2020 Consider also med list drug interactions cost feasibility pt specific sx insomnia hypersomnia fluctuation in appetite 1 anticholinergic effect availability 2 prior tx response chronicity functional status tolerability of prior tx 3 pt preference 1 3 dosin
By vgreene, 4 October, 2020 Consider safety side effect profile eg constipation diarrhea nausea dizziness insomnia somnolence sexual dysfxn1 SGA use during pregnancy may be assoc w small uarr risk of preeclampsia postpartum hemorrhage miscarriage perinatal death preterm birth seroto
