Management and Treatment of Major Depression and Anxiety Disorders

The key objective in treating depressive and anxiety disorders is remission of all symptoms. Studies in the treatment of major depression have consistently shown that lack of remission is associated with higher relapse rates, more severe subsequent depressions, shorter duration between episodes, continued impairment in work settings and social relationships, increased all-cause mortality, and increased risk of suicide (Judd et al., 2000). Initiation of treatment should include education about the expected temporal course of improvement; importance of regular eating, activity, social interaction, and sleep; medication selection; follow-up schedule; and safety management if symptoms worsen or suicidal ideation is evident (Box 47-7).

Box 47-7 Initiation of Treatment for Major Depression and Anxiety Disorders

1. Educate the patient. Details of illness

Treatment course, prognosis, goal of treatment (remission of symptoms)

Importance of general health: exercise, sleep hygiene, nutrition

Inclusion of family when possible

Coordination with other providers

Resource lists for support groups, therapy referrals

2. Select medication from reasonable choices. Patient history of antidepressant use/response Family history of antidepressant response Typical time course to antidepressant response

3. Administer starting dose, and initiate dose titration. Common side effects of medications

4. Establish monitoring with measurement-based care (e.g., QIDS).

5. Schedule follow-up in 2 to 4 weeks.

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