ABSTRACT
Major depressive disorder (MDD) is a common psychiatric illness affecting nearly 20% of adults in the United States at least once during their lifetime. MDD is frequently diagnosed and treated in the primary care setting. Management of the disease may be complicated by patients and family members feeling stigmatized by the diagnosis and not understanding that depression is a treatable medical illness, which, in turn, fosters low rates of adherence to treatment recommendations. Incomplete or delayed response to treatment, adverse events associated with antidepressants and medical or psychiatric comorbidities also interfere with optimal depression management. This article presents an overview of diagnostic and treatment guidelines for MDD and focuses on challenges encountered by primary care physicians. The role of antidepressant medications, psychotherapy and nonpharmacologic interventions for the treatment of patients with MDD is described, and factors influencing treatment selection, such as adverse event profiles and patient characteristics, are examined.
Subject(s)
Depressive Disorder, Major/therapy , Adult , Algorithms , Antidepressive Agents/therapeutic use , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/drug therapy , Humans , Primary Health Care , United StatesABSTRACT
Type 2 diabetes is associated with increased risk for the development of cardiovascular disease (CVD) secondary to hyperglycemia's toxicity to blood vessels. The escalating incidence of CVD among patients with type 2 diabetes has prompted research into how lowering glycated hemoglobin (HbA(1c)) may improve CVD-related morbidity and mortality. Data from recent studies have shown that some patients with type 2 diabetes actually have increased mortality after achieving the lowest possible HbA(1c) using intensive antidiabetes treatment. Multiple factors, such as baseline HbA(1c), duration of diabetes, pancreatic beta-cell decline, presence of overweight/obesity, and the pharmacologic durability of antidiabetes medications influence diabetes treatment plans and therapeutic results. Hypertension and dyslipidemia are common comorbidities in patients with type 2 diabetes, which impact the risk of CVD independently of glycemic control. Consideration of all of these risk factors provides the best option for reducing morbidity and mortality in patients with type 2 diabetes. Based on the results of recent trials, the appropriate use of current antidiabetes therapies can optimize glycemic control, but use of intensive glucose-lowering therapy will need to be tailored to individual patient needs and risks.
