Vol. 22, No. 4 / November 2010

Effective Strategies for Patients With Complex Depression in Psychiatric Practice

TARGET AUDIENCE

This activity is designed to meet the needs of psychiatrists and other mental health care professionals who are interested in the management of patients with major depressive disorder (MDD).

PROGRAM OVERVIEW

MDD is a serious chronic illness that affects the lives of millions of patients and their families, and poses challenges for psychiatrists caring for these individuals. Despite the availability of effective treatments, many patients with MDD fail to achieve remission, the primary goal of therapy. More than half of patients either do not respond or only partially respond to first-line antidepressants. In addition, comorbid chronic medical conditions complicate the clinical presentation and treatment decisions, and require special consideration. A number of effective pharmacologic treatment strategies have been studied for patients in these challenging situations, including switching to another approved antidepressant, combining treatment with an approved antidepressant agent, and augmenting with an agent of a different class.

This supplement focuses on the identification of difficult-to-treat patients with MDD and presents evidence-based intervention strategies to increase the rate of patients who achieve remission, thus improving their overall health.

LEARNING OBJECTIVES

After completing this activity, participants should be better able to:

• Explain the rationale for using augmentation, combination, and switching as strategic approaches for individual patients with difficult-to-treat depression

• Utilize switching as a treatment strategy in patients with MDD who have not responded in a therapeutic trial of a first-line agent

• Develop evidence-based strategies to combine and augment pharmacologic regimens in patients with treatment-resistant depression

• Recognize the importance of identifying patients with comorbid chronic medical conditions and of implementing appropriate changes in strategy to manage these patients

Release Date: November 1, 2010
Expiration Date: November 1, 2011

This supplement is based on a symposium, “Effective Strategies for Patients With Complex Depression in Psychiatric Practice: A Case-Based Approach,” held April 8, 2010, at the Sheraton Chicago Hotel and Towers, Chicago, Illinois, in conjunction with the 2010 Current PsyChiatry/American Academy of Clinical Psychiatrists Conference, and represents the same content material.

ACTIVITY CHAIRPERSON

Philip R. Muskin, MD
Professor of Clinical Psychiatry
Columbia University
Chief of Service: Consultation-Liaison Psychiatry
Department of Psychiatry
Columbia University Medical Center
Research Psychiatrist
New York State Psychiatric Institute
New York, New York

FACULTY

Andrew A. Nierenberg, MD
Associate Director, Depression Clinical and Research Program
Co-Director, Bipolar Clinic and Research Program
Massachusetts General Hospital
Boston, Massachusetts
Professor of Psychiatry
Harvard Medical School
Boston, Massachusetts

George I. Papakostas, MD
Director, Treatment-Resistant Depression Studies
Massachusetts General Hospital
Boston, Massachusetts
Associate Professor of Psychiatry
Harvard Medical School
Boston, Massachusetts

ACCREDITATION STATEMENT

SciMed is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CREDIT DESIGNATION

SciMed designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim credit commensurate only with the extent of their participation in the activity.

DISCLOSURE AND RESOLUTION OF CONFLICTS OF INTEREST

SciMed assesses conflicts of interest with its faculty and all individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are resolved by SciMed to ensure fair balance and scientific objectivity. When asked to report any potential conflict(s) of interest, the faculty reported the following:

Philip R. Muskin, MD
Speakers bureau: AstraZeneca, Bristol-Myers Squibb Company, Jazz Pharmaceuticals
Retained consultant: Otsuka America Pharmaceutical, Inc

Andrew A. Nierenberg, MD
Grants/research support: Bristol-Myers Squibb Company; Cederroth AB; Cyberonics, Inc; Eli Lilly and Company; Forest Laboratories, Inc; GlaxoSmithKline; Janssen Pharmaceutica; Lichtwer Pharma; NARSAD; NIMH; Pfizer Inc; Shire; The Stanley Foundation; Wyeth-Ayerst Laboratories
Retained consultant: Abbott Laboratories; AstraZeneca; Basilea Pharmaceutica, Ltd; BrainCells Inc; Bristol-Myers Squibb Company; Eli Lilly and Company; EPI-Q, Inc; Genaissance Pharmaceuticals, Inc; GlaxoSmithKline; Innapharma Inc; Janssen Pharmaceutica; Jazz Pharmaceuticals; Merck & Co, Inc; Novartis; Pfizer Inc; PGxHealth; Schering-Plough; Sepracor Inc; Shire; Somerset Pharmaceuticals, Inc; Takeda Pharmaceuticals North America, Inc; Targacept, Inc
Honoraria: Bristol-Myers Squibb Company; Cyberonics, Inc; Eli Lilly and Company; Forest Laboratories, Inc; GlaxoSmithKline; MGH Psychiatry Academy; Physicians Postgraduate Press, Inc; Shire; Wyeth-Ayerst Laboratories Stock shareholder: Appliance Computing II, Inc (Mindsite); BrainCells Inc

George I. Papakostas, MD
Grants/research support: Bristol-Myers Squibb Company; Forest Laboratories, Inc; Pamlab LLC; Pfizer Inc; Precision Human Biosystems
Retained consultant: AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Pamlab LLC, Wyeth Pharmaceuticals
Honoraria for non–speakers bureau presentations: AstraZeneca, Bristol-Myers Squibb Company, GlaxoSmithKline, Lundbeck Inc, Otsuka America Pharmaceutical, Inc

Shari Fallet, DO, an employee of SciMed, reports owning stock options in Pfizer Inc. All other SciMed personnel involved in the development of content for this activity have no relevant conflicts to report.

The materials for this activity were peer reviewed by Joseph Goldberg, MD, Associate Clinical Professor of Psychiatry, Mount Sinai School of Medicine; and Jeffrey Strawn, MD, Assistant Professor, Departments of Psychiatry and Behavioral Neuroscience and Pediatrics, University of Cincinnati College of Medicine. Dr Goldberg disclosed that he is a retained consultant for Eli Lilly and Company and is on the speakers bureaus for AstraZeneca; Eli Lilly and Company; GlaxoSmithKline; Janssen-Cilag; Merck & Co, Inc; and Pfizer Inc. Dr Strawn has no relevant conflicts to report.

The symposium materials were peer reviewed by Richard Balon, MD, Professor, Department of Psychiatry and Behavioral Neurosciences, Wayne State University. Dr Balon has no relevant conflicts to report.

CREDIT REQUIREMENTS

There are no fees for participating in and receiving CME credit for this activity. To obtain CME credit for participating in this activity between the period November 1, 2010, through November 1, 2011, participants must:

• Read the learning objectives and disclosure statements

• Study the entire educational activity

• Complete the posttest by recording the best answer to each question

• Complete the activity evaluation, which includes a request-for-credit section

• Mail or fax the evaluation form with answer key to SciMed per the instructions on the form

Participants will be mailed a certificate or statement of credit within 4 to 6 weeks.

DISCLAIMER

The opinions or views expressed in this CME activity are those of the presenters and do not necessarily reflect the opinions or recommendations of SciMed or the commercial supporter. Participants should critically appraise the information presented and are encouraged to consult appropriate resources for information surrounding any product, device, or procedure mentioned.

Annals of Clinical Psychiatry ©2010 Quadrant HealthCom Inc.