Episode 16: Anti-Depressants: Is there a Drug of Choice?
In episode 16 we look at initiating treatment for depression. We briefly review screening and the diagnosis of depression before discussing the non-drug treatment options (therapy, exercise, sleep hygiene). We search for the anti-depressant of choice (being any) and end up deciding to tailor the choice based on factors such as side-effect profile, targeted symptoms, and cost. Although we stress the importance of regular follow-up, James refuses to come to see Mike or Adil.
Show Notes
1) Two screening questions for depression – do you feel depressed, do you have little interest in doing things
J Gen Intern Med. 1997;12:439-45
2) Benefit seen in 1 week with antidepressants
Arch Gen Psychiatry 2006;63:1217-23
3) No difference between the second generation antidepressants in effect
Ann Intern Med. 2005;143 :415-26
4) Weight benefit with fluoxetine.
Arch Intern Med 2004;164:1395-1404
5) Amitriptyline is as effective as other tricyclics or newer agents
6) Monitoring form for using antidepressants in children and adolescents
7) Clinical tool to monitor antidepressant treatment
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