Maintenance phase treatment
after relapse, 6
combining medication and
psychotherapy, 122-123
definition of, 2, 150
for geriatric patients, 100
objectives and indications for, 2, 27,
110-112

recurrence prevention as result of, 43
using medication, 112-118

using psychotherapy, 112, 118-122
Major depressive disorder. See also
Depression

coding medical records for, 10
definition of, 150

description of, 7, 9

economic costs for treatment of, 9
family history of, 1, 111, 112
in geriatric population, 99-102
prevalence of, 1, 7, 9

recurrence or relapse of. See
Recurrence/relapse;

Recurrence/relapse prevention
risk factors for, 1, 7, 9, 100
seasonal, 102-103

social stigma attached to, 1, 7, 9-10
suicide and, 97, 98. See also Suicide
Mania, 150

Maprotiline

continuation/maintenance phase
studies with, 115
pharmacology of, 59

randomized controlled trials using,
47-49, 54

side effects of, 56

tapering off use of, 117

therapeutic range for, 58

Marital therapy. See also Acute phase
psychotherapy; Psychotherapy
during continuation/maintenance
phase, 120

evidence for efficacy of, 76
indications for, 80, 83
Medical conditions. See also

Concurrent medical conditions
as risk factor for depression, 100
suicide and presence of, 97
treatment for depressive episodes
biologically caused by, 5
Medical records, 10

Medical Research Council Study, 114
Medication. See also Antidepressant

medication; individual medications
acute phase management with. See
Acute phase medication
benefits and harms of, 24
combined with psychotherapy. See
Combined treatment

comparisons between summary
statistics for trials of psychotherapy
and, 18-19

during continuation/maintenance
phase, 112-118

decision to augment, 68, 69

discontinuation of, 109, 117-118, 123
effectiveness of, 3

evidence for efficacy of, 44-54,
113-116

evidence tables for, 16
following electroconvulsive therapy,
110

for geriatric patients, 55, 100, 101.
See also Geriatric patients
objectives and indications for, 2,
35-37

as option for acute treatment, 39-40
outcome measures for, 15
overview of responses to, 1, 3-5
side effects of, 3, 30, 37, 40, 55-56,
61-62, 69. See also Side effects
for treatment of concurrent medical
conditions, 40, 46, 104
use of stimulant, 102
willingness to take, 10
Medication dosage adjustment
during acute phase management,
61-62

during combined treatment, 93
during continuation or maintenance
treatment, 116, 117

to correct underdosage, 64, 66-67
Medication selection

in case of likely overdose, 57
criteria for acute phase, 55-61
decision to switch, 68-69
Melancholic features, 151

Meta-analysis, 16

for acute phase treatment, 45
of antidepressant medications for

intent-to-treat samples, 48-53
generalizability issues in use of, 19-20
methodology and limitations of, 17-20
potential problems with interpretation
of, 20-21

of primary care antidepressant trials,
54
Monoamine oxidase inhibitors (MAOIs)
criteria for selection of, 57, 58, 60, 61
pharmacology of, 59

randomized controlled trials using, 44,
45, 47, 50, 51

recurrence/relapse rate using, 115
response to, 3, 43, 68-69
side effects of, 56

tapering off use of, 117-118
Mood disorders, 151

side effects of, 3, 55, 56
tapering off use of, 117-118
Patients

with cancer, 104

considerations regarding family
history of, 111, 112
education to improve treatment
adherence by, 10, 28, 30-31
fears regarding depression, 10
shared decision making between
physicians and, 2, 38
tolerance of side effects by, 4
treatment preferences of, 72
treatment refusal by, 42

willingness to take medication, 10
Personality disorders

response in patients with, 83

treatment compliance in patients with,
30

treatment for depression concurrent
with, 90, 106, 122

Phenelzine

acute phase trials for, 47, 50, 51
pharmacology of, 59

relapse/recurrence rate with, 115
Physicians. See Primary care
practitioners

Pill placebo controls, 19

Placebo

efficacy of medication vs., 37

inpatient vs. outpatient response rates
with, 45

Primary care practitioners

recommendations regarding treatment
by, 13

referrals made by, 123-124
Primary care settings, studies testing
efficacy of medication in, 40, 52-53

Protriptyline

pharmacology of, 59

randomized controlled trials using,
47-49

side effects of, 56
Psychiatric disorders

relationship between major depressive
and other, 107

selection of medication for non-mood,
56-57

treatment of depressive disorder
concurrent with, 5, 105-106, 108
Psychiatric settings, studies testing
efficacy of medication in, 40, 52-53
Psychosocial problems

addressing patient's, 37

following good symptomatic response
to medication, 65

interference with treatment due to,
102

Psychotherapy. See also Behavioral
therapy; Brief dynamic

psychotherapy; Cognitive therapy;
Combined treatment; Interpersonal
psychotherapy; Marital therapy

acute phase treatment with. See Acute
phase psychotherapy

benefits and harms of, 24-25
combined with medication. See
Combined treatment

comparisons between summary
statistics for trials of medication
and, 18-19

continuation/maintenance treatment
with, 6, 65, 109-110, 112, 118-122
effects of, 2, 35, 37

efficacy of, 6, 43, 73-84, 99
evidence tables for, 16
explanation of, 71

as first-line therapy, 4, 40-41, 71. See
also Acute phase psychotherapy
objectives and indications for, 2,
70-74, 104

outcome measures for, 15-16
randomized controlled trials for, 13,
20, 40-41, 43, 72, 75-77, 104
response to, 1, 3, 32, 33, 82-83
used for cancer patients, 104
Psychotic depression, management of,
95, 96

R

Randomized controlled trials

for acute phase medication, 39-40,
44-54

analysis of, 13-16

applicability of evidence derived
from, 19-20

for combined treatment, 41, 92,
122-123

for continuation/maintenance
medication, 113-116

for electroconvulsive therapy, 96
in geriatric population, 99-100. See
also Geriatric patients
placebo run-in period in, 40

for psychotherapy, 13, 20, 40-41, 43,
72, 75-77, 104

Recurrence/relapse

after ending continuation medication,
6

during continuation/maintenance

phase, 6, 113-116, 121-122
expectations regarding, 27
Recurrence/relapse prevention
acute phase psychotherapy for, 72
continuation/maintenance treatment
for, 43, 109-116, 121, 122
as treatment objective, 35
Referrals

during acute treatment, 38

made by primary care physicians,
123-124

recommendations regarding need for,

Sertraline

pharmacology of, 59

randomized controlled trials using, 47,
50, 51

relapse/recurrence rate using, 115
response to, 68

as selection for outpatients, 60
side effects of, 3, 55, 56
tapering off use of, 117-118
Side effects. See also individual drugs
of electroconvulsive therapy, 26, 27
of medication, 3, 4, 30, 37, 40, 55-56,
61-62, 69

patient tolerance of, 4, 40

treatment compliance due to, 30
Social skills training, 78, 119
Social stigma, 1, 7, 9-10
Somatization disorder, 151

Stimulant medication, 102
Substance abusers

suicide and, 97

randomized controlled trials using,
47-49, 54

response to, 68, 69

as selection for outpatients, 60
side effects of, 3, 55, 56
tapering off use of, 117-118
Treatment. See also Combined
treatment; Electroconvulsive

therapy; Light therapy; Medication;
Psychotherapy

adverse effects of, 23

benefits and harms of, 24-27
clinical management of, 27-28. See
also Clinical management
for episodes biologically caused by
medical disorders, 5

for episodes concurrent with
psychiatric disorder, 5, 105-106, 108
forms of, 1, 2

improving adherence to, 28-31
objectives and indications for, 1,
23-24, 35, 43-44, 72
overview of, 29

patient preferences regarding, 72
patient refusal of, 42
phases of, 27, 28

reevaluation of, 3-4

studied in randomized controlled
trials, 14-15. See also individual

treatments; Randomized controlled
trials

Treatment adherence

frequency of physician visits to
optimize, 38

patient education to improve, 10, 28,
30-31

rates of, 28-29

Treatment outcome

assessment of, 31, 38

measures of, 15-16

scoring of, 16

Treatment response. See also Failure to
respond; individual forms of

treatment

decision to switch or augment
treatment based on, 32-33, 68-70
length of time for assessment of,
31-32

Trials. See Randomized controlled trials
Tricyclic antidepressants (TCAs). See
also individual drugs

criteria for selection of, 57, 58, 60-61
discontinuation of, 117

dosage adjustments for, 61, 68
pharmacology of, 59

randomized controlled trials using, 45,
47-49, 53, 54

response to, 64-65, 68, 69
side effects of, 3, 55
tapering off use of, 109
Trimipramine

pharmacology of, 59

randomized controlled trials using,

47-49

side effects of, 56

W

World Health Organization (WHO),
111