"DEPRESSION"

OUTLINE

DEPRESSION IS COMMON

DEPRESSION IS SIGNIFICANT

DEPRESSION IN DIABETES

 DEPRESSION
IN CARDIAC DISEASE

 DEPRESSION
and ASTHMA IN CHILDREN

UNDER-RECOGNITION/
UNDERTREATMENT

TYPES OF DEPRESSION


MAJOR DEPRESSION

DEPRESSED MOOD
Hallmark 1

ANHEDONIA
 Hallmark 2

PHYSICAL SYMPTOMS
 Hallmark 3

PSYCHOLOGICAL SYMPTOMS Hallmark 4

DSM-IV CRITERIA FOR MAJOR DEPRESSION

CHRONIC DEPRESSION (DYSTHYMIA)

MINOR DEPRESSION

Slide 18

ASSESSMENT

Patient Health Questionnaire: (PHQ)

USE OF THE PHQ

SCORING THE PHQ: SEVERITY

PHQ-9 Compared to Clinician Assessment of MDD

BARRIERS TO RECOGNITION

DIVERSITY AND DEPRESSION

THE SPIRIT CATCHES YOU
AND YOU FALL DOWN
Anne Fadiman

WHAT CAUSED THE ILLNESS?

 WHAT CAUSED THE ILLNESS?

HOW WAS IT TREATED?

“JUST ASK…”

STRATEGIES FOR DIVERSITY

‘TACCT’

Tailored Approach for
Caring and Counseling Transculturally

T.A.C.C.T.

BEFORE TACCT…
ELICIT EXPLANATORY MODEL

T.A.C. C. T.

Slide 36

INTEGRATION OF DEPRESSION:
PRACTICE DESIGN

SELF-MANAGEMENT SUPPORT: SIX FUNCTIONS

DECISION SUPPORT:
ACUTE DEPRESSION

Three Phases of Treatment

SPECIALIST
DECISION SUPPORT

Consultation,
Collaboration, or Referral

OFFICE COUNSELING:
NON-SPECIFIC SUPPORT

"S schedule regular activities"

TREATMENT SELECTION:
FOUR OPTIONS

WATCHFUL WAITING (WW)

PSYCHOTHERAPY

PHARMACOTHERAPY

ANTIDEPRESSANTS

"TREATMENT GUIDELINES:"

PARTIAL OR NO RESPONSE

TREATMENT GUIDELINES:
CONTINUTATION TREATMENT

TREATMENT GUIDELINES:
TO MAINTAIN OR NOT TO MAINTAIN?

PHQ-9 Initial Rx. Guidelines

PHQ-9: Monthly Follow-Up Guide
for Clinically Significant Depression

TRICYCLIC ANTIDEPRESSANTS

ADVANTAGES OF SSRIs AND OTHER NEW AGENTS

CHOOSING AMONG SSRIs AND OTHER NEW AGENTS

HALF-LIFE

DRUG INTERACTIONS

"DRUG INTERACTIONS
(ANTIDEPRESSANT INHIBITION"

CHOOSING SSRIs

POTENTIAL ROLE OF  DUAL AGENTS 
(venlafaxine, tricyclics, others)

VENLAFAXINE VS. SSRIs

ANTIDEPRESSANTS IN
DIABETES

ANTIDEPRESSANTS IN
CARDIAC DISEASE

Slide 67

Slide 68

SIDE EFFECTS
(SSRIs)

SIDE EFFECTS
(other new agents)

MANAGING SIDE EFFECTS

MANAGING SIDE EFFECTS

COMORBID ANXIETY/PANIC

Slide 74

"The"