University of Texas

Southwestern Medical Center, Dallas, Texas

M. Trivedi, MD,

Scientific Assistant to the Chair
M. White, MM, Project Manager
L. Arnold

W. Hendrickse, MD, MRCP
G. Kramer

D. Savage

Agency for Health Care
Policy and Research,
Rockville, Maryland
J.J. Clinton, MD,
Administrator

K. McCormick, PhD, RN,
Director, Office of the Forum
E. Corrigan

C. Crofton, PhD

G. Hernandez, RN
S. King, MD

V. Montgomery

K. Pearson, RPh, MPH
R. Siegel

L. Williams

Editorial Associates,
Washington, District of
Columbia
G. Martin

Fast Word, Dallas, Texas
Health Systems Research,
Washington, District of
Columbia

MedStat Systems, Inc.,
Ann Arbor, Michigan

Mikalix & Company,
Waltham, Massachusetts
M. Madison, MPA, and staff
Moshman and Associates,
Bethesda, Maryland

National Institute of Mental
Health, Bethesda, Maryland
F. Goodwin, MD, Director
J. Burke, MD, MPH
J. Gonzales, MD

A. Leshner, PhD

G. Norquist, MD, MSPH
National Library of Medicine,
Bethesda, Maryland

I. Auston, MLS, and staff
University of California
at Los Angeles, California
D. Schriger, MD, MPH
University of California
at Berkeley, California
T.W. Hu, PhD

University of Pittsburgh
Medical Center,
Pittsburgh, Pennsylvania
M. McDonald, MFA

Washington Consulting Group,
Inc., Washington, District of
Columbia
C.L. Smith

Acute phase electroconvulsive therapy
(ECT). See also Electroconvulsive
therapy

efficacy for use of, 96

indications for, 41, 95-96

Acute phase medication. See also
Medication

adding psychotherapy to, 70. See also
Acute phase combined treatment;
Combined treatment
consultations regarding, 70
dosage adjustments for, 61-62

drug blood levels for, 57, 62-64

evidence for efficacy of, 44-54

failure to respond to, 64-69. See also
Failure to respond

frequency of visits for, 61
indications for, 43-44

selection of, 55-61

Acute phase psychotherapy. See also
Psychotherapy

decision to add or substitute

medication for, 88. See also Acute
phase combined treatment;
Combined treatment
evidence for efficacy of, 74-82
factors affecting response to, 82-83
failure to respond to, 85-86
frequency of visits for, 85
objectives and indications for, 71-74
selection of, 84-85

definition of, 149

family history of, 111, 112

maintenance trials for patients with, 114

seasonal depression and, 103 Blood levels

during continuation or maintenance treatment, 116

determination of antidepressant drug, 62-64

medication selection and monitoring, 57

patients in need of monitoring, 63-64, 100

for selected antidepressants, 58-59 symptom breakthrough and, 117 Brief dynamic psychotherapy. See also Acute phase psychotherapy; Psychotherapy

combined with medication, 91

Clinical Global Impression (CGI), 15, 18

Clinical management

explanation of, 1, 87, 149

function and importance of, 1-2, 27-28, 43

of medication, 43-44. See also Acute phase medication; Medication supportive therapy vs., 23 Clomipramine

pharmacology of, 59 therapeutic range for, 58

for treatment of non-mood psychiatric disorder, 56

Cognitive therapy. See also Acute

phase psychotherapy; Psychotherapy combined with medication, 87, 91-93 during continuation/maintenance phase, 118-119 definition of, 149

evidence for efficacy of, 75-77, 82-83 frequency of visits for, 85 goal of, 75

side effects of, 56
therapeutic range for, 58
Dysthymic disorder, 150

E

Electroconvulsive therapy (ECT)
benefits and harms of, 26-27

as choice for acute treatment, 41,
95-96

continuation treatment following, 110
criteria for selection of, 57, 95
definition of, 150

objectives and indications for, 2, 35
recommendations for use of, 5
side effects of, 26, 27

treatment of geriatric patients with,
99-100

Evidence tables, 16

F

Failure to respond. See also Treatment
response

to acute phase combined treatment,
93-94

to acute phase psychotherapy, 85-86
continuation of medication for, 66-67
to medication, 64-67

medication switching due to, 68-69
Families

depression education for, 10, 30, 31
history of bipolar disorder or
depression within, 1, 111, 112
referrals requested by, 124
response to different classes of
medication in, 58
Fluoxetine

continuation/maintenance studies
using, 11

dosage used for, 61-62, 64
pharmacology of, 59

randomized controlled trials using, 47,
50, 51, 54

response to, 67-69

as selection for outpatients, 60
side effects of, 3, 55, 56, 61-62
tapering off use of, 117-118

therapeutic range for, 58

for treatment of psychiatric disorder,
56, 108