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Combination therapy may be required for symptom management. Combination therapy is useful when additional medications to target depression symptoms are required. Some clients may not be candidates for combination therapy due to a lack of adherence to the medication regimen. First line combination th...

Combination therapy may be required for symptom management. Combination therapy is useful when additional medications to target depression symptoms are required. Some clients may not be candidates for combination therapy due to a lack of adherence to the medication regimen. First line combination therapy for bipolar 1 or manic episode with depressive features includes: Lithium or valproic acid + lamotrigine/aripiprazole/Risperidol Major Depressive Disorder (MDD): one of the most common mental disorders affecting approx. 7.1% of adults in the US, Prevalence 13.1% among ages between 18-25. S/S: Depressed mood, loss of interest/pleasure, irritability, withdrawal, problems sleeping/eating/energy/concentration or self-worth are all signs and symptoms of major depressive disorder. Pt.’s with severe depression may experience thoughts of suicide/ psychotic symptoms. If antidepressant therapy for major depressive disorder is mistaken for bipolar depression what could happen? It may precipitate a manic episode/ induce a rapid-cycle bipolar depression & contribute to the incidence of death by suicide in children & adults < 25 yrs of age. 1st line treatment for severe depression includes SSRI, SNRI, & bupropion. Monoamine hypothesis of depression, prescribing considerations- Depression occurs because of a deficiency of one or all 3 monoamine transmitters (serotonin, NE, & dopamine) is the monoamine hypothesis of depression. Monamine neurotransmitters are norepinephrine, dopamine, & serotonin