about depression

1. Score Severity Guide
0-4
None-
minimal
Don't need
treatment
5-9 Mild
Use clinical
judgment about
treatment based
on symptoms
10-14 Moderate
Use clinical
judgment about
treatment based
on symptoms
15-19 Moderately
Severe
Treatment using
antidepressant
with
psychotherapy
20-27 Severe
Treatment using
antidepressant
with or without
psychotherapy
❖ Patient-rating instruments. Answers
to the questions are used to identify
and assess the level of depression.
PHQ-9
MAJOR DEPRESSIVE
DISORDER

2. Guidelines
Special Population:
• Pregnancy: ECT, Brexanolone (GABA-
A modulator) is an antidepressant
specifically for postpartum depression
• Geriatrics: SSRIs, SNRIs, bupropion,
and mirtazapine.
• Pediatrics: Fluoxetine and
escitalopram are
the only antidepressants FDA
approved.
1st
line treatment
SSRIs, SNRIs, Bupropion, Mirtazapine
-Assess Response after 6-8
weeks by HAM-D
-Response >50%
(Reduction in symptoms )
If Remission : continue
for 4-9 months to prevent
relapse
Partial or no response
1.Extending
medication
or using
higher doses.
2.Augmentation
therapy by adding
Li, buspirone or
anticonvulsants
3.Combination
Therapy by adding
antidepressants
from different class.
4. Switching to a different
class from short t1/2 to
longer one. e.g. Sertraline
to fluoxetine.
5.Add
psychotherap
y or initiate
ECT