A Guideline for the Medical Management of Major Depressive Disorder - Flowchart
A Guideline for the Medical Management of Major Depressive Disorder - Flowchart
«Flowchart»

MEDICAL MANAGEMENT OF MAJOR DEPRESSIVE DISORDER ALGORITHM

MEDICAL MANAGEMENT OF MAJOR DEPRESSIVE DISORDER ALGORITHM

MEDICAL MANAGEMENT OF MAJOR DEPRESSIVE DISORDER ALGORITHM

MEDICAL MANAGEMENT OF MAJOR DEPRESSIVE DISORDER ALGORITHM

Determine whether there is a history of good response to a medication in the pt or a first-degree relative; if yes, consider treatment with this agent if compatible with considerations in step 2.

Determine whether there is a history of good response to a medication in the pt or a first-degree relative; if yes, consider treatment with this agent if compatible with considerations in step 2.

Determine whether there is a history of good response to a medication in the pt or a first-degree relative; if yes, consider treatment with this agent if compatible with considerations in step 2.

Evaluate pt characteristics and match to drug; consider health status, side effect profile, convenience, cost, pt preference, drug interaction risk, suicide potential, and medication compliance history.

Evaluate pt characteristics and match to drug; consider health status, side effect profile, convenience, cost, pt preference, drug interaction risk, suicide potential, and medication compliance history.

Evaluate pt characteristics and match to drug; consider health status, side effect profile, convenience, cost, pt preference, drug interaction risk, suicide potential, and medication compliance history.

Begin new medication at 1/3 to 1/2 target dose if drug is a TCA, bupropion, venlafaxine, or mirtazapine, or full dose as tolerated if drug is an SSRI.

Begin new medication at 1/3 to 1/2 target dose if drug is a TCA, bupropion, venlafaxine, or mirtazapine, or full dose as tolerated if drug is an SSRI.

Begin new medication at 1/3 to 1/2 target dose if drug is a TCA, bupropion, venlafaxine, or mirtazapine, or full dose as tolerated if drug is an SSRI.

If problem side effects occur, evaluate possibility of tolerance; consider temporary decrease in dose or adjunctive treatment.

If problem side effects occur, evaluate possibility of tolerance; consider temporary decrease in dose or adjunctive treatment.

If problem side effects occur, evaluate possibility of tolerance; consider temporary decrease in dose or adjunctive treatment.

If unacceptable side effects continue, taper drug over 1 week and initiate new trial; consider potential drug interactions in choice.

If unacceptable side effects continue, taper drug over 1 week and initiate new trial; consider potential drug interactions in choice.

If unacceptable side effects continue, taper drug over 1 week and initiate new trial; consider potential drug interactions in choice.

Evaluate response after 6 weeks at target dose; if response is inadequate, increase dose in stepwise fashion as tolerated.

Evaluate response after 6 weeks at target dose; if response is inadequate, increase dose in stepwise fashion as tolerated.

Evaluate response after 6 weeks at target dose; if response is inadequate, increase dose in stepwise fashion as tolerated.

If inadequate response after maximal dose, consider tapering and switching to a new drug vs adjunctive treatment; if drug is a TCA, obtain plasma level to guide further treatment.

If inadequate response after maximal dose, consider tapering and switching to a new drug vs adjunctive treatment; if drug is a TCA, obtain plasma level to guide further treatment.

If inadequate response after maximal dose, consider tapering and switching to a new drug vs adjunctive treatment; if drug is a TCA, obtain plasma level to guide further treatment.

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SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.

SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.

SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.