Phase I | Treatment-resistant Depression in the Primary Care Setting |
· Formulate a treatment plan at the start of therapy | |
· Prior to switching or augmenting an antidepressant consider a longer trial (12–14 weeks) at a therapeutic dose | |
· Triiodothyronine (T3, cytomel) is an effective and well tolerated augmentation agent | |
Use of Atypical Antipsychotics in Treatment –resistant Depression | |
· Consider T3 (or lithium) prior to considering atypical antipsychotic augmentation agent | |
· Atypical antipsychotics are associated with metabolic abnormalities and require regular monitoring | |
Phase II | Pharmacotherapy options for Insomnia |
· Cognitive behavior therapy and pharmacologic treatment approaches have similar effectiveness | |
· All sedative/hypnotics appear to be comparable in treating insomnia | |
· Clinical data regarding sedating antidepressants and antipsychotics are lacking | |
Clinical use and comparative effectiveness of benzodiazepines | |
· Long-term benzodiazepine use is rarely warranted | |
· Withdrawal of benzodiazepine has led to improvements in cognitive functioning, balance, and memory without worsening insomnia (particularly in frail elderly) | |
· Discontinuation should always include gradual tapering |