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Flashcards in Major Depressive Disorder Tx Deck (16):

How to measure remission

Tools for symptom severity (PHQ-9)
Ask about side effects
Ask about adherence
Ask about functional status


If no remission achieved, patient is vulnerable

More sig psychosocial disability
3x faster relapse
Signifies a more chronic illness if the was the first MDE
Even mild residual symptoms place patients at more risk for relapse than a history of MDE


Continuation Phase: Goal of Treatment

Sustain Remission


Continuation Phase: Treatment

Monitor for early signs of relapse
Systematic review of symptoms, side effects, adherence and functional status
Medications continued for 4-9 months
Depression-focused CBT to prevent relapse
If ECT was used in the acute phase, pharmacotherapy


If ECT was used in acute phase, what pharmacotherapy is best?

Lithium and nortriptyline


Which symptoms of depression will subside first?

Vegetative symptoms


Maintenance Phase: Goal of treatment

Prevent recurrence


Rate of MDE recurrence



MDE increases risk for...

Other affective episodes like mania and hypomania


If ≥ 3 MDE or chronic MDE...

Some form of maintenance therapy will be needed indefinitely


Each MDE increases risk of recurrence by...



Discontinuation Phase

Treatment free without recurrence
Taper meds over several weeks
Inform pt of chances of relapse, and make a plan if sx recur
Monitor for several months
How to measure remission


Discontinuation Phase: What to do if recurrence of symptoms?

Initiate a full acute phase treatment plan.


Risk for recurrence of MDD

Persistence of subthreshold symptoms
Prior Hx of multiple MDE
Severity of initial and subsequent episodes
Early age of onset
Additional non-affective psych diagnosis
Presence of chronic medical disorder
+ family history of psych illness, esp. mood disorder
Ongoing psychosocial stress and impairment
Negative cog style
Persistent sleep disturbances


Psychotherapy for maintenance

Monthly Interpersonal Therapy
CBT over 2 years as effective as meds
Medication and psychotherapy may be more effective than either as single therapy
Some studies indicate that monthly therapy is as effective as maintenance meds


Acute Phase Treatment Goals

Achieve remission
3 weeks of absence of sad mood and reduced interest
No more than 3 remaining symptoms