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Download filePharmacological management of unipolar depression
journal contribution
posted on 2013-05-01, 00:00 authored by G Malhi, R Hitching, Michael BerkMichael Berk, P Boyce, R Porter, K FritzObjective : To be used in conjunction with ‘Psychological management of unipolar depression’ [Lampe et al. Acta Psychiatr Scand 2013;127(Suppl. 443):24–37] and ‘Lifestyle management of unipolar depression’ [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38–54]. To provide clinically relevant recommendations for the use of pharmacological treatments in depression derived from a literature review.
Method : Using our previous Clinical Practice Guidelines [Malhi et al. Clinical practice recommendations for bipolar disorder. Acta Psychiatr Scand 2009;119(Suppl. 439):27–46] as a foundation, these clinician guidelines target key practical considerations when prescribing pharmacotherapy. A comprehensive review of the literature was conducted using electronic database searches (PubMed, MEDLINE), and the findings have been synthesized and integrated alongside clinical experience.
Results : The pharmacotherapy of depression is an iterative process that often results in partial and non-response. Beyond the initiation of antidepressants, the options within widely used strategies, such as combining agents and switching between agents, are difficult to proscribe because of the paucity of pertinent research. However, there is some evidence for second-line strategies, and a non-prescriptive algorithm can be derived that is based broadly on principles rather than specific steps.
Conclusion : Depression is by its very nature a heterogeneous illness that is consequently difficult to treat. Invariably, situation-specific factors often play a significant role and must be considered, especially in the case of partial and non-response. Consulting with colleagues and trialling alternate treatment paradigms are essential strategies in the management of depression.
Method : Using our previous Clinical Practice Guidelines [Malhi et al. Clinical practice recommendations for bipolar disorder. Acta Psychiatr Scand 2009;119(Suppl. 439):27–46] as a foundation, these clinician guidelines target key practical considerations when prescribing pharmacotherapy. A comprehensive review of the literature was conducted using electronic database searches (PubMed, MEDLINE), and the findings have been synthesized and integrated alongside clinical experience.
Results : The pharmacotherapy of depression is an iterative process that often results in partial and non-response. Beyond the initiation of antidepressants, the options within widely used strategies, such as combining agents and switching between agents, are difficult to proscribe because of the paucity of pertinent research. However, there is some evidence for second-line strategies, and a non-prescriptive algorithm can be derived that is based broadly on principles rather than specific steps.
Conclusion : Depression is by its very nature a heterogeneous illness that is consequently difficult to treat. Invariably, situation-specific factors often play a significant role and must be considered, especially in the case of partial and non-response. Consulting with colleagues and trialling alternate treatment paradigms are essential strategies in the management of depression.
History
Journal
Acta psychiatrica scandinavicaVolume
127Issue
Supplement s443Pagination
6 - 23Publisher
Wiley-Blackwell PublishingLocation
Malden, Mass.Publisher DOI
ISSN
0001-690XeISSN
1600-0447Language
engPublication classification
C1 Refereed article in a scholarly journalUsage metrics
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Categories
Keywords
major depressive disorderantidepressantstreatment algorithmclinical practice guidelinesrecommendationsScience & TechnologyLife Sciences & BiomedicinePsychiatrySEROTONIN REUPTAKE INHIBITORSSTAR-ASTERISK-DANTIDEPRESSANT DRUG-TREATMENTRANDOMIZED CONTROLLED-TRIALSCANMAT CLINICAL GUIDELINESDEEP BRAIN-STIMULATIONMAJOR DEPRESSIONDOUBLE-BLINDELECTROCONVULSIVE-THERAPYTRICYCLIC ANTIDEPRESSANTS