Questions and Answers
Patients with depression are generally optimistic about the future.
False
Feelings of guilt are not a symptom of depression.
False
The treatment plan for depression is solely developed by the clinical team.
False
Depression is a self-inflicted condition.
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The prognosis for individual episodes of depression is poor.
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Medication is the only treatment for depression.
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The original text is an example of a transcription task.
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The original text is written in response to an existing conversation.
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The original text provides a summary of a given image.
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The original text asks for the image to be shared for transcription purposes.
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The original text is a standalone instruction set.
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Depression is a condition that can be overcome with willpower alone.
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A patient's feelings of worthlessness are a common symptom of depression.
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Depression is a condition that only affects young people.
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The treatment plan for depression is developed solely by the patient.
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Psychotherapy is an effective treatment for depression.
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The original text is a response to a request for transcription.
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The conversation in the original text is about a provided image.
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The original text provides guidance on treating depression.
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The original text is a summary of a conversation.
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The original text is a standalone instruction set.
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Inpatient treatment is only recommended for patients who are improving with other measures.
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The decision to involve family members in the treatment of a patient with depressive disorder is optional.
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Antidepressant drug treatment is indicated for all patients with a major depressive syndrome.
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Dysthymia is not an indication for antidepressant medication.
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The patient's social resources, including family, friends, and work, are not factors to consider in managing depressive disorders.
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A patient with a clear history of major depression who develops symptoms of mild depression can never be considered for antidepressant medication.
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The National Institute for Health and Clinical Excellence has not developed guidelines for a stepped-care approach to the management of depression.
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The risk of suicide is not a factor to consider in determining the level of care and supervision required for a patient with depressive disorder.
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Combining antidepressants with antipsychotics is usually the best course of action for non-psychotic resistant depression.
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Lithium is usually not safe and poorly tolerated when combined with antidepressants.
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Atypical antipsychotics have no antidepressant effects when used with SSRIs.
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Withdrawal from first-line antidepressants can lead to a gain of benefits previously not experienced.
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It is not worthwhile to explore augmentation therapy for unresponsive or partially responsive patients.
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The dosage of lithium should start at 400mg daily and increase by a maximum of 400mg weekly.
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If a patient has not responded to one kind of antidepressant, it is recommended to switch to an antidepressant that has the same pharmacological profile.
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When switching between antidepressants with different pharmacological properties, the first compound should be fully withdrawn before starting the second one.
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SSRIs have clear dose-response relationships.
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ECT is a pharmacological treatment for resistant depression.
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Antidepressants should be stopped immediately if the patient is not improving.
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When switching from an SSRI to a different class of drug, the first compound should be fully withdrawn before starting the second one.
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About 25% of patients who are unresponsive to an initial medication trial can benefit from switching to a second antidepressant.
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Lithium can be combined with MAOIs for the treatment of resistant depression.
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If the patient has been taking medication as prescribed, the diagnosis should not be reviewed.
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A meta-analysis of randomized studies suggested that switching to a second SSRI was better than switching to a different class of drug in terms of remission rate.
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The likelihood of another episode of major depression after having three episodes is 50%.
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Lithium is always the first choice for treating long-term major depression.
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Cognitive behavioral therapy is considered less effective than medication for reducing relapse in patients with recurrent major depression.
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A patient's family history can influence the choice of maintenance treatment for depression.
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Individuals are encouraged to maintain a lifestyle that is likely to lead to further illness if their depressive disorder is related to social relationships.
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Study Notes
What Patients and Families Want to Know
- Patients commonly seek answers about their condition, treatment options, recovery, and support for family members.
- Depression is recognized as a medical condition, not a personal failing; feelings of guilt are part of the illness.
- Prognosis for depression episodes is generally good, but patients may exhibit inherent pessimism regarding the future.
- Treatment typically involves a collaborative approach combining psychological support and medication.
Management of Depressive Disorders
- Management level is determined by disorder severity and available social resources.
- Consideration of suicide risk and basic needs (e.g., nutrition) is critical in treatment planning.
- Home treatment may be possible with supportive families, even for severe cases; those without support may need intensive care.
- Family involvement in treatment is highly recommended.
Factors Influencing Treatment Decisions
- Assessments include social support systems, the disorder's impact on others, and the patient’s work capability.
- Antidepressants are indicated for moderate to severe major depressive disorders, especially with melancholic features.
- Previous positive responses to medications or presence of dysthymia may also warrant antidepressant treatment.
Failure to Respond to Initial Treatment
- If no improvement is noted after a reasonable period on medication and therapy, treatment plans should be reassessed.
- Factors such as medication adherence, possible overlooked stressors, and dosage adjustments should be considered.
- High doses of SSRIs can be tried given the absence of clear dose-response relationships in some patients.
Change in Antidepressant Drug Treatment
- Switching to a different antidepressant is common if there's no response to the initial medication.
- Pharmacological treatments may include increasing doses, trying different classes of antidepressants, or combining medications.
- A significant portion of patients (around 50%) may benefit from switching to a second antidepressant after an initial failure.
Augmenting Antidepressant Treatment
- Combination treatment might augment the effectiveness of a partially successful antidepressant.
- Antipsychotic drugs serve as an option primarily in psychotic depression; their role in non-psychotic resistant depression is limited.
- Atypical antipsychotics may provide antidepressant effects when paired with SSRIs but carry potential side effects.
Lithium Augmentation
- Lithium is effective in treating resistant depression and is generally safe when combined with antidepressants.
- It is advisable to initiate lithium at low doses, gradually increasing as tolerated.
Considerations in Augmentation Therapy
- Withdrawal from first-line antidepressants may result in loss of benefits and potential withdrawal symptoms if done hastily.
- For patients who are unresponsive or partially responsive, exploring augmentation therapy can be a viable solution.
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Description
Learn about the common questions patients and families have about depression, what to expect from a practitioner, and general advice on the topic.
