general info 2 Flashcards
True or false - all pt receiving treatment should be monitored for suicidal ideating, particularly in the early weeks of treatment, and for treatment concordance
True
When should you review patients on AD after initiation
usually within 2 weeks of initiation
if at risk of suicide or aged 18-25, review 1 week after starting treatment or increasing dose, with ongoing reviews repeated as often as necessary but within 4 weeks
AD treatment is usually continued for at least …
6 months
management for pt with new episode of subthreshold or mild depression - non drug and drug
psychological and psychosocial therapy e.g. guided self help, CBT, BA
do not routinely offer AD unless pt pref
if this is the case, offer SSRI as appropriate
for pt who decide against treatment offer active motoring with the option to reconsider treatment at any time, and arrange a further assessment (usually within 2-4 weeks)
ideal 1st line for pt with new episode of moderate or severe depression
+ other treatment options
combination therapy with AD + individual CBT
monotherapy with AD or psychological treatment (e.g. individual CBT, BA or problem solving) may also be offers as 1st line
TCAs are associated with the greatest risk on overdose, although this TCA has the best safety profile
lofepramine
Which TCA has the best safety profile
lofepramine
Name the 2 SNRIs
venlafaxine
duloxetine
when can you consider ECT for the treatment of severe depression
rapid response needed
based on pt prev experience
pt preference over other treatments
what to do if pt hasn’t responded after 4 weeks of AD treatment, or after 4-6 weeks of psychological therapy or combined therapy
assess for treatment adherence
consider other factors or health conditions that may explain why treatment is not working
For patients with limited or no response to psychological monotherapy, consider the following 3 options
- switch to alt psychological treatment
- add in SSRI
- switch to SSRI alone
if there has been limited or no response to AD monotherapy, consider the following options
- add group exercise intervention
- switch to psychological therapy
- increase AD dose
- switch to diff AD in same class or different class
- change to combination psychological and AD
For patients with limited or no response to treatment with a combination of psychological therapy and an antidepressant consider the following options
- switching to another psychological therapy
- increasing AD dose
- switch to another AD in same class or different class
- add in another med
When can vortioxetine be considered as a treatment option
for pt with limited or no response to at least 2 AD drugs
in which situations would you consider referring to specialist mental health setting or seeking specialist advice?
- switching to AD from different drug class e.g. TCA or MAOI
- adding in additional AD form different drug class
- combining AD with either 2nd gen antipsychotic, or lithium
- combining AD drugs with ECT, lamotrigine (unlicensed) or liothyronine (unlicensed)
true or false - continuation of treatment following full or partial remission may reduce risk of relapse
true
for pt in remission following psychological treatment alone, but who are at higher risk of relapse, consider ..
continuing psychological therapy
for pt on AD monotherpay who are in remission but at higher risk of relapse, consider
continuing AD
combing AD with course of psychological therapy (e.g. group CBT or mindfulness-based cognitive therapy MBCT)
switch to course of psychological therapy alone
for pt in remission following combination treatment with AD and psychological therapy who are at high er risk of relapse consider
continuing one or both treatments
risk of relapse should be assessed on completion of psychological therapy, and at least every …. months for those who continue on AD treatment
every 6 months
Some patients presenting with chronic depressive symptoms may not have sought treatment for their depression previously. For patients with symptoms that significantly impair functioning, treatment options include
monotherapy with either CBT or drug treatment with an SSRI, SNRI, or a TCA
or combination therapy with CBT and either an SSRI or a TCA
For patients who do not respond to SSRIs or SNRIs, consider alternative drug treatments in specialist settings or on specialist advice (alternatives include TCAs, moclobemide, irreversible MAOIs, or amisulpride [unlicensed use]).
If a patient is taking AD long term to prevent relapse, how often should you review
at least every 6 months to monitor symptoms, check concordance, assess for adverse effects, RF for release, suicidal ideas and their wishes for ongoing treatment
consider using validated questionnaire for depression to monitor response to treatment e.g. PHQ9
