Mental Health Book

Disease Complications

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Depression Medical Management

Aka: Depression Medical Management, Medical Management of Depression
  1. See Also
    1. Refractory Depression Management
    2. Depression Management Special Circumstances
  2. General
    1. Providers tend to under dose depression
      1. Refractory Depression may simply need higher levels
    2. Duration of therapy after remission of symptoms
      1. Young: 6 months minimum treatment
      2. Elderly: 2 years minimum use
      3. Rebound Depression off medication: Indefinite use
        1. Continued use reduces relapse risk by two thirds
        2. Geddes (2003) Lancet 361:653-61 [PubMed]
  3. Protocol
    1. Choosing an Antidepressant
      1. Consider Antidepressant Adverse Effects
      2. Consider Depression Types (see below)
        1. Anxious or agitated
        2. Inhibited or withdrawn
      3. Consider effect on sexual function (see below)
      4. Start with generic agents if possible
    2. Choosing a dosage
      1. Many patients are not on the optimal dose
        1. Write prescription to allow patient to increase
      2. Start at sub-therapeutic dose to reduce side effects
      3. Increase dose to minimum effective dose in 5-7 days
      4. Allow patient to increase dose again in 2-3 weeks
      5. Example: Celexa 20 mg (write for 60 with refills)
        1. Start at 1/2 tablet daily for 5-7 days
        2. Then increase to 1 pill daily for 2-3 weeks
        3. Then consider increase to 2 pills daily
  4. Management: General agents
    1. First choice
      1. Citalopram (Celexa)
      2. Sertraline (Zoloft)
      3. Buproprion (Wellbutrin)
    2. Second choice (due to side effects)
      1. Fluoxetine (Prozac): Activating
      2. Paroxetine (Paxil): Sedating and withdrawal risk
      3. Mirtazapine (Remeron): Sedating and weight gain
        1. Elderly may see side effects as helpful
    3. References
      1. Goad (2007) Chronic Disease Lecture, MPLS
  5. Management: Agitation or Insomnia
    1. Use Sedating Antidepressant
      1. Paroxetine (Paxil)
      2. Mirtazapine (Remeron)
    2. Consider medication to assist sleep
      1. Trazodone (Desyrel) 25-50 mg PO qhs
    3. Consider Benzodiazepine for first 1-2 weeks
      1. Clonazepam
  6. Management: Anxiety
    1. Paroxetine (Paxil)
    2. Venlafaxine (Effexor)
  7. Management: Pain
    1. Duloxetine (Cymbalta)
    2. Venlafaxine (Effexor)
    3. Tricyclic Antidepressant
  8. Management: Psychotic Depression
    1. See Depression with Psychotic Features Management
  9. Management: Inhibited Depression
    1. First Line: SSRI
      1. Fluoxetine (Prozac)
      2. Bupropion (Wellbutrin)
    2. Second Line: Tricyclic Antidepressant
      1. Imipramine (Tofranil)
      2. Desipramine (Norpramin)
      3. Protriptyline (Vivactil)
  10. Management: Sexual Dysfunction
    1. See Antidepressant Induced Sexual Dysfunction
    2. Man with Premature Ejaculation: Paxil
    3. Woman lacks orgasm: Buspar 30 minutes prior to sex
    4. Agents least likely to affect sexual function
      1. Nefazodone (Serzone)
      2. Bupropion (Wellbutrin)
      3. Mirtazapine (Remeron)
      4. Citalopram (Celexa)
      5. Fluvoxamine (Luvox)
  11. Management: Perimenopausal Major Depression
    1. Estrogen Replacement effective as Antidepressant
      1. Soares (2001) Arch Gen Psychiatry 58:529-34 [PubMed]
  12. Management: Depression Refractory to Antidepressants
    1. See Refractory Depression Management
  13. References
    1. Ables (2003) Am Fam Physician 67(3):547-4 [PubMed]
    2. Bridges (1995) Br J Hosp Med 54:501-6 [PubMed]
    3. Cadieux (1998) Am Fam Physician 58(9):2059-62 [PubMed]
    4. Little (2009) Am Fam Physician 80(2):167-72 [PubMed]
    5. Ruhe (2006) J Clin Psychiatry 67:1836-1855 [PubMed]
    6. Rupke (2006) Am Fam Physician 73(1):83-86 [PubMed]

Major Depressive Disorder (C1269683)

Definition (MSH) Marked depression appearing in the involution period and characterized by hallucinations, delusions, paranoia, and agitation.
Definition (PSY) Affective disorder marked by dysphoric mood, inactivity, lack of interest, insomnia, feelings of worthlessness, diminished ability to think, and thoughts of suicide. Use DEPRESSION (EMOTION) for nonclinical depression.
Definition (CSP) one or more periods of depression in the absence of history of manic or hypomanic episodes; chronic type lasts 2 or more years; melancholic type is more severe, has vegetative signs, and responds well to somatic therapy.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D003865
ICD10 F32.9
SnomedCT 370143000, 35489007
English Disorder, Major Depressive, Disorders, Major Depressive, Major Depressive Disorders, MDD, MAJOR DEPRESSIVE DISORDER, DEPRESSIVE DIS MAJOR, MAJOR DEPRESSIVE DIS, Major depressive disorder NOS, Major depressive illness, Major depression NOS, Depressive Disorder, Major [Disease/Finding], major depressive illness, major depressive disorder, major depression, Major depressive disorder (diagnosis), Major depression, Major depressive disorder (disorder), Major depressive disorder, Major depression, NOS, Major depressive disorder, NOS, Depressive Disorder, Major, Depressive Disorders, Major, Major Depressive Disorder, Major Depression
Dutch depressieve ziekte, depressieve stoornis NAO, major depression, Depressieve stoornis, ernstige, Ernstige depressieve stoornis, Involutiepsychose, Melancholie, involutionele, Parafrenie, involutionele, Psychose, involutionele, Involutiedepressie, Involutionele depressie
French Syndrome dépressif majeur SAI, Épisode dépressif majeur, Dépression grave, Grave dépression, Dépression majeure, Trouble dépressif majeur
German Major Depression NNB, schwere depressive Krankheit, Endogene Depression, Involutionsdepression, Melancholie, Involutions-, Paraphrenie, Involutions-, Psychose, Involutions-, Depressive Störung, majore, Majore depressive Störung
Italian Depressione maggiore NAS, Malattia depressiva maggiore, Depressione maggiore, Disturbo depressivo maggiore
Portuguese Doença depressiva major, Perturbação depressiva major NE, Depressão grave, Transtorno Depressivo Maior
Spanish Trastorno depresivo mayor NEOM, Enfermedad depresiva mayor, depresión mayor, trastorno depresivo mayor (trastorno), trastorno depresivo mayor, Depresión mayor, Trastorno Depresivo Mayor
Japanese 大うつ病NOS, オオウツビョウ, ダイウツビョウ, ダイウツビョウNOS, うつ病-退行期, 大うつ病性障害, 大鬱病, うつ病-更年期, 大うつ病, 初老期うつ病, 更年期うつ病, 更年期鬱病, 精神病-更年期, 退行期うつ病, 退行期パラフレニー, 退行期メランコリア, 退行期精神病, 鬱病-更年期, パラフレニー-退行期, 更年期うつ状態, 更年期メランコリー, 更年期精神病, 更年期鬱状態, 精神病-退行期, 退行期鬱病
Swedish Involutionsdepression
Czech psychóza involuční, deprese involuční, depresivní porucha unipolární, melancholie involuční, parafrenie involuční, Velké depresivní onemocnění, Velká deprese, Velká depresivní porucha NOS
Finnish Laaja-alainen masentuneisuushäiriö
Russian DEPRESSIVNOE RASSTROISTVO TIAZHELOE, DEPRESSIIA INVOLIUTSIONNAIA, MELANKHOLIIA INVOLIUTSIONNAIA, PSIKHOZ INVOLIUTSIONNYI, PARAFRENIIA INVOLIUTSIONNAIA, ДЕПРЕССИВНОЕ РАССТРОЙСТВО ТЯЖЕЛОЕ, ДЕПРЕССИЯ ИНВОЛЮЦИОННАЯ, МЕЛАНХОЛИЯ ИНВОЛЮЦИОННАЯ, ПАРАФРЕНИЯ ИНВОЛЮЦИОННАЯ, ПСИХОЗ ИНВОЛЮЦИОННЫЙ
Polish Wielkie zaburzenie depresyjne, Zaburzenie depresyjne wielkie, Ciężkie zaburzenie depresyjne, Depresja wielka, Parafrenia inwolucyjna, Depresja głęboka, Epizod depresji dużej, Depresja inwolucyjna
Hungarian Major depressiós betegség, Major depressio, Major depressiós zavar k.m.n.
Norwegian Depresjon, alvorlig, Markert depresjon, Depresjon, markert, Alvorlig depresjon, Markant depressiv forstyrrelse
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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