Response : ( 50% ↓ in symptoms), may take 1-2 months. Remission : ( Return to normal ), may need 3 months. Recovery (The Goal) Remission≥6 months. 4. Relapse : having episode of depression after response or remission 5. Recurrence having episode of depression after recovery

1. Treatment Algorithm for Depression
Prof. Sawsan Aboul-Fotouh
Department of pharmacology, faculty of Medicine, Ain-Shams University

2. Goals of Treatment “5R’s”
1. Response : ( 50% ↓ in symptoms), may take 1-2 months.
2. Remission : ( Return to normal ), may need 3 months.
3. Recovery (The Goal) Remission≥6 months.
4. Relapse : having episode of depression after response or remission
5. Recurrence having episode of depression after recovery

3. ”In continuation phase “6 months from remission,
Maintenance phase 1 year free from symptoms (1st episode), or 2 years (2nd episode or more) ???

4. Atypical & Resistant
ECT
Trial =
4 Weeks
1st Line
Lithium
Lamotrigine
T3 , SGA
Antipsychotics
APA, 2009
NICE, 2010
Monotherapy
Maximize dose
Change to other
member or other class
Combination
Augmentation

5. Sudden Discontinuation :
A withdrawal syndrome
( GI complain, insomnia, restlessness, drowsiness,
Disequilibrium, muscle aches, apathy, headache..)
So, Gradual withdrawal over 4 weeks.

6. ➢ NO craving,
➢ NO compulsive use,
➢ NO intentional overuse,
➢ NO “getting high,”
➢ NO true tolerance
Antidepressants are not addictive
↑↑Risk