Key Concepts

Classic views as to the cause of major depressive disorder (MDD) focus on the monoamine neurotransmitters norepinephrine (NE), serotonin (5-HT), and to a lesser extent, dopamine (DA) in terms of both synaptic concentrations and receptor functioning.

It is not uncommon for a patient to experience only a single major depressive episode, but most patients with MDD will experience multiple episodes.

One extremely important goal in the treatment of MDD is the prevention of suicidal attempts.

Sexual dysfunction is common and challenging to manage and often leads to noncompliance with serotonergic medications.

O Each antidepressant has a response rate of approximately 60% to 80%, and no antidepressant medication or class has been reliably shown to be more efficacious than another.

It is widely accepted that approximately 2 to 4 weeks of treatment are required before improvement is seen in emotional symptoms of depression, such as sadness and anhedonia. Furthermore, as long as 6 to 8 weeks of treatment may be required to see the full effects of antidepressant therapy.

© Because the typical major depressive episode lasts 6 months or longer, if anti-depressant therapy is interrupted for any reason following the acute phase, the patient may relapse into the depressive episode. When treating the first depressive episode, antidepressants must be given for an additional 4 to 9 months in the continuation phase for the purpose of preventing relapse.

® Pediatric patients and young adults should be observed closely for suicidality, worsened depression, agitation, irritability, and unusual changes in behavior, especially during the initial few months of therapy or at times of dosage changes. Furthermore, families and caregivers should be advised to monitor patients for such symptoms.

Lack of patient understanding concerning optimal antidepressant drug therapy frequently leads to partial compliance or noncompliance with therapy; thus, the primary purpose of antidepressant counseling is to enhance compliance and improve outcomes.

My spirit is broken, my days are cut short, the grave awaits me.

Contrary to popular belief, major depression is not a fleeting "bad day," is not the result of personal weaknesses or character flaws, and does not respond to volitional efforts simply to feel better. Major depressive disorder (MDD) is a serious medical condition with a biological foundation, and it responds to biological and psychological treatments. Individuals who suffer from MDD experience significant and pervasive symptoms that can affect mood, thinking, physical health, work, and relationships. Unfortunately, suicide is often the result of MDD that has not been diagnosed and treated adequately.

The last two decades have seen improvements in the screening, diagnosis, and treatment of MDD. The willingness of general practitioners to involve themselves in the identification and treatment of MDD is noteworthy. To that end, antidepressants have become some of the most commonly prescribed drugs, and they account for 10

of the top 100 prescription drugs dispensed in the United States.1 Inadequate treatment remains a serious concern.

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