Finally ^^ Guidline Flyer 2.docx______________________

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1. MAJOR DEPRESSIVE
DISORDER
Score Severity Guide
0-4
None-
minimal
Don't need
treatment
5-9 Mild
Use clinical
judgment about
treatment based
on symptoms
10-14Moderate
Use clinical
judgment about
treatment based
on symptoms
15-19Moderately
Severe
Treatment using
antidepressant
with
psychotherapy
20-27Severe
Treatment using
antidepressant
with or without
psychotherapy
PHQ-9
Patient-rating instruments.
Answers to the questions are
used to identify and assess the
level of depression

2. v
Partial or no response
If Remission :
continue for 4-9
months to prevent
relapse
1.Extending
medication or
using higher
doses.
3.Combination
Therapy by
adding
antidepressants
from different
class .
2.Augmentation
therapy by
adding Li,
buspirone or
anticonvulsants
4 .Switching to a
different class
from short t1/2 to
longer one. e.g.
Sertraline to
fluoxetine.
5.Add
psychotherap
y or initiate
ECT
Special Considerations:
• Pregnancy: ECT, Brexanolone (GABA-
A modulator) is an antidepressant
specifically for postpartum depression
• Geriatrics: SSRIs, SNRIs, bupropion,
and mirtazapine.
• Pediatrics: Fluoxetine and escitalopram are
the only antidepressants FDA
approved.
1
st
line treatment
SSRIs, SNRIs, Bupropion, Mirtazapine
-Assess Response after 6-
8 weeks by HAM-D
-Response >50%
(Reduction in symptoms )
Guidelines