Subject(s)
Depressive Disorder, Major , Individuality , Life Style , Psychotherapy , Psychotropic Drugs/therapeutic use , Combined Modality Therapy , Depressive Disorder, Major/psychology , Depressive Disorder, Major/therapy , Disease Management , Humans , Models, Psychological , Patient Education as Topic , Practice Patterns, Physicians' , Primary Health CareABSTRACT
OBJECTIVE: To be used in conjunction with 'Psychological management of unipolar depression' [Lampe et al. Acta Psychiatr Scand 2013;127(Suppl. 443):24-37] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of pharmacological treatments in depression derived from a literature review. METHOD: Using our previous Clinical Practice Guidelines [Malhi et al. Clinical practice recommendations for bipolar disorder. Acta Psychiatr Scand 2009;119(Suppl. 439):27-46] as a foundation, these clinician guidelines target key practical considerations when prescribing pharmacotherapy. A comprehensive review of the literature was conducted using electronic database searches (PubMed, MEDLINE), and the findings have been synthesized and integrated alongside clinical experience. RESULTS: The pharmacotherapy of depression is an iterative process that often results in partial and non-response. Beyond the initiation of antidepressants, the options within widely used strategies, such as combining agents and switching between agents, are difficult to prescribe because of the paucity of pertinent research. However, there is some evidence for second-line strategies, and a non-prescriptive algorithm can be derived that is based broadly on principles rather than specific steps. CONCLUSION: Depression is by its very nature a heterogeneous illness that is consequently difficult to treat. Invariably, situation-specific factors often play a significant role and must be considered, especially in the case of partial and non-response. Consulting with colleagues and trialling alternate treatment paradigms are essential strategies in the management of depression.
Subject(s)
Antidepressive Agents , Depressive Disorder, Major/drug therapy , Depressive Disorder, Treatment-Resistant , Medication Therapy Management , Antidepressive Agents/administration & dosage , Antidepressive Agents/adverse effects , Depressive Disorder, Major/psychology , Depressive Disorder, Treatment-Resistant/etiology , Depressive Disorder, Treatment-Resistant/therapy , Drug Monitoring/methods , Evidence-Based Practice , Humans , Medication Adherence , Practice Guidelines as Topic , Referral and Consultation , Treatment OutcomeABSTRACT
Males react adversely more frequently than females to intravenous fluorescein angiography, as shown in a study of 547 patients. Approximately 10% of all cases reacted: 12.8% of the male patients and 7.3% of the female patients had adverse responses. Nausea was most common; vomiting was infrequent, and urticaria rare (1.1%). Ten males as opposed to one female reacted markedly. More serious reactions did not occur during the 7 year testing period. No apparent cause for the increased frequency in the male cases was found.
