Special populations

Question 1

CAP MDD 1st line

Answer 1

• CBT, IPT
• Internet-based pyschotherapy (for milder cases if in-person is not available).

Question 2

CAP MDD 2nd line

Answer 2

• Fluoxetine
• Escitalopram, Sertraline, Citalopram

Question 3

CAP MDD, treatment resistance/no response

Answer 3

1st line: add SSRI to psychotherapy

2nd line: switch to another SSRI

Question 4

Preg mild to moderate MDD, 1st/2nd line

Answer 4

1st line: CBT, IPT

2nd line: Citalopram, Escitalopram, Sertraline

Question 5

Preg severe MDD, 1st/2nd lines

Answer 5

1st line: Citalopram, Escitalopram, Sertraline

2nd line:
- Bupriopion, Desvenlafaxine, Duloxetine, Fluoxetine, Fluvoxamine, Mirtaz, TCA (caution with clomipramine), Venlafaxine
- ECT (severe, psychotic, TRD)
- Combo SSRI + CBT/IPT
- Other therapy

Question 6

Breastfeeding mild to moderate MDD, 1st/2nd line

Answer 6

1st line: CBT, IPT

2nd line: Citalopram, Escitalopram, Sertraline, Combo SSRI + CBT/IPT

Question 7

Breastfeeding severe MDD, 1st/2nd line

Answer 7

1st line: Citalopram, Escitalopram, Sertraline, Combo SSRI + CBT/IPT

2nd line:
- Structured exercise, acupuncture, therapist-assisted internet CBT or BA
- Fluoxetine, Fluvoxamine, Paroxetine, TCAs (NO Doxepin)
- Bupropion, Desvenlafaxine, Duloxetine, Mirtaz, Venlafaxine, TMS, bright-light therapy
- ECT (severe, psychtic, TRD)
- Other therapy

Question 8

Perimenopausal MDD, 1st/2nd line

Answer 8

1st line: Desvenlafaxine, CBT

2nd line:
- Transdermal estradiol
- Citalopram, Duloxetine, Escitalopram, Mirtaz, Seroquel XR, Venlafaxine XR
- Omega-3 FA, Fluoxetine, Nortriptyline, Paroxetine, Sertralina