By vgreene, 4 October, 2020 If pt unwilling/unable to engage in 1st-line psychotherapy or pharma-co tx: Consider exercise as monotherapy and bibliotherapy as alternative;VA 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 (SJW) monotherapy hypericin (0.1%-0.3% or hyperforin (1%-6%), therapeutic dose 500-1800 mg daily. In combo with SSRIs &
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 consid
By vgreene, 4 October, 2020 If choosing psychotherapy CBT1 or non CBT as initial tx Evidence doesn t favor one type vs another 1 3 Pt preference guides use of CBT as 1st line or adjunctive tx 1 or individual vs group tx3
By vgreene, 4 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 short term psychodynami
