By vgreene, 4 October, 2020 Options SSRIs citalopram escitalopram sertraline 1 3 but not fluvoxamine fluoxetine per VA 3 SNRIs start low dose 1 3 duloxetine venlafaxine desvenlafaxine levomilnacipran Atypical antidepressants bupropion 1 mirtazapine 1 3 nefazodone 1 trazodone 1 3 vil
By vgreene, 4 October, 2020 If no MDD hx prior to pregnancy Refer for psychotherapy as 1st line tx evidence doesn t favor one specific psychotherapy type vs another 1 3 If pregnant pt had MDD hx prior to pregnancy responded to antidepressant meds is stable on pharma co tx Weigh risk
By vgreene, 4 October, 2020 ACT, BA/BT, CBT, IPT, MCBT, PSTVA,ACP are 1st-line, evidence-based psychotherapy options
By vgreene, 4 October, 2020 Monitor pts at least monthly after tx start/change until remission; measure sx, adherence to med/psychotherapy, & adverse effects; counsel re sleep hygiene, need to abstain from ETOH until sx resolve; refer/treat any nicotine dependence; consider these sp
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
