Webmd.com
This review examines the antidepressants that are currently used as the initial or "first-line" therapies for major depressive disorder (MDD). These newer medications may be grouped into three classes: the selective serotonin reuptake inhibitors, the serotonin and norepinephrine reuptake inhibitors, and the norepinephrine-dopamine reuptake inhibitor.
Healthline.com
10 rows · May 15, 2010 · Consider sertraline and escitalopram as first-line agents for initial treatment of major ...
Top10homeremedies.com
15 rows · Olanzapine/fluoxetine combination. The first approved treatment for acute bipolar depression ...
What is the newest treatment for depression?
Jun 17, 2020 · First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months.
What is the first line medication for depression?
Among the various mood stabilizers, there is ample evidence to suggest that lithium and lamotrigine may be used as the first line medications in the management of bipolar depression. If the patient presents with a breakthrough episode, the initial strategy is to check the medication compliance and ensure adequate compliance.
What is the best type of therapy for depression?
Apr 21, 2020 · All CPGs included serotonin selective reuptake inhibitors (SSRIs) as first-line treatment; however, one CPG also included agomelatine, milnacipran, and mianserin as first-line alternatives. Recommendations for depression subtypes (catatonic, atypical, melancholic) were included in three CPGs.
What is first line therapy for depression?
noradrenaline reuptake inhibitors (SNRIs), bupropion, mirtazapine, and several newer agents are typically used as first-line medications because their safety and tolerability may be preferable to patients and clinicians compared to those of tricyclic antidepressants (TCAs) and monoamine oxidase (MAO) inhibitors.
What is the first line of treatment for major depression?
Consider sertraline and escitalopram as first-line agents for initial treatment of major depression in adults. The least tolerated antidepressants in this study were bupropion, fluoxetine, paroxetine, and duloxetine.May 15, 2010
What is the most important treatment for depression?
Exercise. Regular exercise can be as effective at treating depression as medication. Not only does exercise boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just like antidepressants do.
What type of therapy is used for depression?
Cognitive Behavioral Therapy (CBT) Cognitive behavioral therapy, or CBT, helps an individual identify and change negative thoughts and associated behaviors. People who suffer from depression often struggle with negative thought patterns.May 19, 2021
What interventions are used to treat depression?
There are many different talking therapies that can be effective in treating depression:cognitive behavioural therapy (CBT)group-based CBT.interpersonal therapy (IPT)behavioural activation.psychodynamic psychotherapy.More items...
Why do we need multiple treatment meta-analysis?
A multiple-treatments meta-analysis will allow us to be better informed about the options that are available and will allow development of treatment guidelines that reflect the best available evidence.
Is bupropion the same as fluoxetine?
Paroxetine (Paxil) and bupropion (Wellbutrin) are similar to fluoxetine in effectiveness and tolerability. Fluvoxamine and duloxetine (Cymbalta) are less effective than fluoxetine. See Table 1 for a comparison of antidepressants available in the United States. 2.
What is the management of depression?
Management of depression involves comprehensive assessment and proper establishment of diagnosis. The assessment must be based on detailed history, physical examination and mental state examinations. History must be obtained from all sources, especially the family.
What is the first line of antidepressants?
In general, because of the side effect and safety profile, selective serotonin reuptake inhibitors (SSRIs) are considered to be the first line antidepressants. Other preferred options include tricyclic antidepressants, mirtazapine, bupropion, and venlafaxine.
What are the areas of assessment?
Area to be covered in assessment include symptom dimensions, symptom-severity, comorbid psychiatric and medical conditions, particularly comorbid substance abuse, the risk of harm to self or others, level of functioning and the socio-cultural milieu of the patient.
Why is ECT used in continuation phase?
There are evidences to support the use of specific psychotherapy in continuation phase to prevent relapse. The use of other somatic modalities (e.g. ECT) may be useful in patients where pharmacology and/or psychotherapy have failed to maintain stability in continuation phase.
What to do after discontinuing treatment?
After the discontinuation of active treatment, patients shouldbe reminded of the potential for a depressive relapse. Patient may be again informed about the early signs of depression, and a plan for seeking treatment in the event of recurrence of symptoms may be formulated.
What is maintenance phase treatment?
The goal of maintenance phase treatment is to prevent recurrence of depressive episodes. On an average, 50-85% of patients with a single episode of major depression have at least one more episodes. Therefore, maintenance phase treatment may be considered to prevent recurrence.
What are the determinants of psychotherapy?
The major determinants of type of psychotherapy are patient preference and the availability of clinicians with appropriate training and expertise in specific psychotherapeutic approaches. Other clinical factors which will influence the type of psychotherapy include the severity of the depression.
When did the ACP publish the MDD guidelines?
The American Psychiatric Association published guidelines for major depressive disorder (MDD) in 2010 3 and the American College of Physicians (ACP) published their guidelines in 2016. 4 Antidepressants are recommended as an initial treatment option.
What percentage of older adults have depression?
I. Background and Objectives for the Systematic Review. Depression is a common psychiatric disease in older adults. Approximately 15–20 percent of adults older than age 65 in the United States have experienced depression. 1. Multiple systematic reviews have shown that antidepressant medications are better than placebo for treating depression in ...
What is AHRQ method guide?
The methods for this comparative effectiveness review follow the guidance provided in the Agency for Healthcare Research and Quality (AHRQ) Methods Guide for Effectiveness and Comparative Effectiveness Reviews for the Evidence-based Practice Center (EPC) program. 9
What is a key informant?
Key Informants are the end users of research, including patients and caregivers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience in making health care decisions.
Is antidepressant better than placebo?
Multiple systematic reviews have shown that antidepressant medications are better than placebo for treating depression in older patients. 2 However, effects are modest and side effects are common.
Which type of therapy has the highest level of evidence?
Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use.
What is psychoeducation for anxiety?
Psychoeducation includes information about the physiology of the bodily symptoms of anxiety reactions and the rationale of available treatment possibilities.
How long did Alice stay on Venlafaxine?
The psychiatrist advised Alice to continue on venlafaxine for at least 6 months. Then, the drug was slowly tapered, by reducing the dose to 150 mg/d for 1 month, then to 75 mg/d for another month. Then, after 2 weeks on 37.5 mg/d, the medication was stopped.
What is a switch to a drug?
Switch to a drug (or drug combination) that has been reported to be effective in case reports. PDA. - The addition of lithium to clomipramine and the combination of valproate and clonazepam have been reported to be effective in refractory cases.
What is the differential diagnosis of anxiety?
The differential diagnosis of anxiety disorders includes common mental disorders, such as other anxiety disorders, major depression, and somatic symptom disorders, as well as physical illnesses such as coronary heart or lung diseases, hyperthyroidism, and others.
What is the definition of phobias?
Phobias which are restricted to singular, circumscribed situations, often related to animals (eg, cats, spiders, or insects), or other natural phenomena (eg, blood, heights, deep water). Mixed Anxiety and Depressive Disorder F41.2. Simultaneous presence of anxiety and depression, with neither predominating.
What are the symptoms of somatic anxiety?
Patients suffer from somatic anxiety symptoms (tremor, palpitations, dizziness, nausea, muscle tension, etc.) and from psychic symptoms, including concentrating, nervousness, insomnia, and constant worry, eg, that they (or a relative) might have an accident or become ill. Social Phobia F40.1.
How many people are affected by depression?
Depression is the most prevalent psychiatric disorder, which affects more than 300 million individuals [ 2 ]. It is an incapacitating disorder, responsible for most of the 800,000 annual suicides [ 2 ]. Along with population growth and aging, the number of individuals with depression has also increased considerably and led to overloaded healthcare ...
What are the recommendations of CPGs?
All CPGs included recommendations for the treatment of those who did not respond or partially responded to first-line therapy . Such recommendations are synthesized in Table 3 and details are presented in S2 Table. Almost all recommendations were considered strong regarding the adjustment of drug dosages when there was a lack of response to the initial pharmacological treatment. Moreover, antipsychotic agents were recommended as an augmentation strategy by five CPGs.
What is a CPG in medicine?
Clinical practice guidelines (CPGs) for treatment of depression, founded on scientific evidence, are essential to improve patient care. However, economic and sociocultural factors may influence CPG elaboration, potentially leading to divergences in their recommendations.
Is SSRI a first line treatment?
All CPGs considered SSRIs as a first-line antidepressant treatment . However, we identified two important discrepancies. Besides SSRIS, as options, the CANMAT CPG recommended the use of agomelatine, milnacipran, and mianserin [ 25 ]; and the Colombian CPG recommended the use of amitriptyline [ 22] as first-line treatment based on pharmacoeconomic studies.
Is pharmacological treatment for depression considered a strategy?
First, it should be noted that pharmacological treatment of depression is one of the strategies that should be considered to ensure adequate patient care. Pharmacotherapy should be prescribed only after a careful evaluation of the patient, including risk of suicide, requirement of hospitalization, indication of psychotherapy, and existence of comorbidities among other clinical and psychosocial aspects.
Is milnacipran a CPG?
The CANMAT CPG recommendation of milnacipran as a first-line treatment is based more on its tolerability than on its efficacy [ 37 ], which does not follow the recommended sequence for the rational use of medicines: efficacy, availability, and safety [ 38 ].
What is the most studied psychotherapy for depression?
The most studied psychotherapy for depression, CBT has the largest weight of evidence for its efficacy. Interpersonal psychotherapy (IPT) is a structured and brief intervention addressing social issues that maintain depression. It can be administered in individual or group formats. It is short-term and problem-focused.
How effective is interpersonal therapy for depression?
Interpersonal psychotherapy (IPT) has proved effective in pediatric depression; focusing on helping individuals decrease interpersonal conflicts by teaching them interpersonal problem-solving skills and helping them modify communication patterns. Psychotherapy seems to be more effective for youth ages 12 to 18 years.
What are the factors that determine the selection of an antidepressant?
Antidepressant selection should be individualized based on clinical factors, including symptom profile, comorbidity, tolerability profile, previous response, potential drug-drug interactions, patient preference, and cost. No antidepressant has been clearly shown to be superior to another; all FDA-approved antidepressant medications should be considered potentially appropriate for first-line treatment.#N#Selective serotonin reuptake inhibitors (SSRIs), serotonin and#N#noradrenaline reuptake inhibitors (SNRIs), bupropion, mirtazapine, and several newer agents are typically used as first-line medications because their safety and tolerability may be preferable to patients and clinicians compared to those of tricyclic antidepressants#N#(TCAs) and monoamine oxidase (MAO) inhibitors.#N#Mirtazapine and other mixed-target medications can be particularly useful in depression associated with insomnia and weight loss due to side effects of sedation and increased appetite. Bupropion’s mixed effects on monoamines (including dopamine) may be helpful for patients with lethargy and increased appetite. Bupropion has also shown promise for attention-deficit disorder, nicotine addiction and several appetitive disorders.
How many sessions of CBT are needed for anhedonia?
CBT can be administered in individual or group formats. It is short-term (e.g., 20 sessions) and problem-focused. The most studied psychotherapy for depression, CBT has the largest weight of evidence for its efficacy.
How prevalent is major depressive disorder?
Major Depressive Disorder (MDD) Major depressive disorder, or MDD, is a highly prevalent and costly medical condition with a lifetime prevalence of about 16 percent among U.S. adults and a 12-month prevalence of about 7 percent; about 13.5 million adults experienced MDD in the past year and 34 million will experience it at some point, ...
What is cognitive behavioral therapy?
Cognitive-behavioral therapy (CBT) is effective as a monotherapy in depression in youth. CBT focuses on identifying. cognitive distortions that may lead to depressed mood and also utilizes problem -solving, behavior activation, and emotion-regulation skills to help manage and combat depression.
How many symptoms are there for a symtom?
For a diagnosis, four additional symptoms are required, including weight loss or gain; sleep disruptions; slowing down or speeding up of physical movements; fatigue or loss of energy; thoughts of worthlessness; difficulty with decision-making; and recurrent thoughts of death or suicide.
I. Background and Objectives For The Systematic Review
- Depression is a common psychiatric disease in older adults. Approximately 15–20 percent of adults older than age 65 in the United States have experienced depression.1 Multiple systematic reviews have shown that antidepressant medications are better than placebo for treating depression in older patients.2 However, effects are modest and side effects...
II. The Key Questions
- Draft key questions (KQs) and a contextual question (CQ) were posted for public comment in August 2017 prior to the topic refinement phase. Comments from the public, AHRQ, the AGS and Key Informant (KI) Panel were considered by the EPC during topic refinement and the following revisions were made. We removed the specific age threshold defining "older adults" from the qu…
III. Analytic Framework
- Abbreviations:CNS=central nervous system; KQ=key question; MDD= major depressive disorder; SIADH=syndrome of inappropriate antidiuretic hormone; SNRI=selective serotonin norepinephrine inhibitor; SSRI=selective serotonin reuptake inhibitor
IV. Methods
- The methods for this comparative effectiveness review follow the guidance provided in the Agency for Healthcare Research and Quality (AHRQ) Methods Guide for Effectiveness and Comparative Effectiveness Reviews for the Evidence-based Practice Center (EPC) program.9 Criteria for Inclusion/Exclusion of Studies in the Review: Inclusion and exclusion criteria for the K…
v. References
- CDC Promotes Public Health Approach to Address Depression among Older Adults https://www.cdc.gov/aging/pdf/cib_mental_health.pdf. Accessed Nov 2, 2017
- Kok RM, Reynolds CF III, Management of Depression in Older Adults A Review. JAMA. 2017;317(20):2114-22.
- Gelenberg AJ, Freeman MP, Markowitz JC et al. Practice guideline for the treatment of patien…
- CDC Promotes Public Health Approach to Address Depression among Older Adults https://www.cdc.gov/aging/pdf/cib_mental_health.pdf. Accessed Nov 2, 2017
- Kok RM, Reynolds CF III, Management of Depression in Older Adults A Review. JAMA. 2017;317(20):2114-22.
- Gelenberg AJ, Freeman MP, Markowitz JC et al. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. American Psychiatric Association 2010.
- Qaseem A, Barry MJ, Kansagara D, et al. Nonpharmacologic versus pharmacologic treatment for adult patients with major depressive disorder: a clinical practice guideline from the American College of...
VII. Summary of Protocol Amendments
- If we need to amend this protocol, we will give the date of each amendment, describe the change and give the rationale in this section. Changes will not be incorporated into the protocol. Example table below:
VIII. Review of Key Questions
- The Agency for Healthcare Research and Quality (AHRQ) posted the key questions on the AHRQ Effective Health Care Website for public comment. The Evidence-based Practice Center (EPC) refined and finalized the key questions after review of the public comments, and input from Key Informants and the Technical Expert Panel (TEP). This input is intended to ensure that the key q…
IX. Key Informants
- Key Informants are the end users of research, including patients and caregivers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience in making health care decisions. Within the EPC program, the Key Informant role is to provide input into identifying the Key Questions for research that will inform …
X. Technical Experts
- Technical Experts constitute a multi-disciplinary group of clinical, content, and methodological experts who provide input in defining populations, interventions, comparisons, or outcomes and identify particular studies or databases to search. They are selected to provide broad expertise and perspectives specific to the topic under development. Divergent and conflicting opinions ar…
XI. Peer Reviewers
- Peer reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. The EPC considers all peer review comments on the draft report in preparation of the final report. Peer reviewers do not participate in writing or editing of the final report or other products. The final report does not necessarily represent the views of in…