NSSANoradrenergic and specific serotonergic

NHRI Norepinephrine and dopamine reuptake

SAR] Serotonin antagonist and reuptake inhibitor

SARI Serotonin antagonist and reuptake inhibitor

SNRI Serotonin and norepinephrine reuptake

SSRI S elec Live seroLon i n reup I ake in h i bitor

Patient Care and Monitoring

1. Assess the patient's severity of symptoms to determine if patient-directed therapy is appropriate or whether a psychiatrist should evaluate the patient.

2. Obtain a thorough history of prescription, nonprescription, natural, and illicit drug use. Rule out medications or medical disorders that may cause or mimic depressive symptoms.

3. Review Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria to determine an appropriate diagnosis.

4. Determine appropriate pharmacologic and psychological treatments (e.g., cognitive-behavioral therapy), including what has been helpful to the patient in the past.

5. Educate patient and/or caretaker about the disease state, lifestyle modifications, and medication therapy.

• What risk factors are present that could contribute to depression?

• What lifestyle modifications could be made to improve condition (e.g., exercise)?

• How the medication should be taken?

• What potential adverse effects may occur?

• Which drugs may interact with their therapy?

• Warning signs and prevention of suicidal and/or homicidal ideation.

6. Develop a plan to assess effectiveness of pharmacologic therapy after 4 weeks of being on a clinically effective dose.

7. Evaluate the patient for the presence of adverse drug reactions, drug allergies, and drug interactions.

8. Assess improvement in quality-of-life measures such as physical, psychological, and social functioning and well-being.

9. If the patient does not respond, determine if the patient is taking the appropriate medication and dose.

10. Recommend changes in therapy if the patient does not respond.

11. Determine long-term maintenance therapy.

^ Self-assessment questions and answers are available at ht-tp://www. mhpharmacotherapy. com/pp.html.

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