Our group, Morning Medicine (coming soon) is working on developing our treatment algorithms for a number of common primary care problems.
These next few posts are on the resources we are using to develop our depression diagnosis and treatment algorithm.
The Curbsiders have had three excellent podcasts and show notes on the treatment of depression:
- #140 Psychopharmacology 2.0, Antidepressant Master Class
FEBRUARY 18, 2019 By MATTHEW WATTO, MD Featuring Patrick Finley PharmD from UCSF
- #115 Geriatric Depression: Diagnosis, Antidepressants, and More
SEPTEMBER 24, 2018 By MATTHEW WATTO, MD with Geriatric Psychiatrist, Dennis Popeo MD - #35: Depression: MDD with DJ MMC
APRIL 17, 2017 By MATTHEW WATTO, MD with Dr. Marius Marcel Commodore
I’ve reviewed the show notes of each of the podcasts and they are excellent.
Another resource that I found very useful was emedicine.medscape.com‘s article Depression Updated: Aug 29, 2018 Author: Jerry L Halverson, MD.
All of the above resources have excellent information on the diagnosis and treatment of depression but none have a comprehensive algorithm for the treatment of depression.
I also reviewed Acute and Longer-Term Outcomes in Depressed Outpatients Requiring One or Several Treatment Steps: A STAR*D Report [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Am J Psychiatry. 2006 Nov;163(11):1905-17.
The above article is cited by over 100 PubMed Central articles.
The above article has the following flow chart:
There are a number of good Depression Toolkits for Primary Care available with a Google search.
One that we will be using as a basis for our primary care depression treatment algorithm is the 2015 CCNC Adult Depression Toolkit for Primary Care [PDF].
See also the Texas Medication Algorithm Project Procedural Manual: Major Depressive Disorder Algorithm.
And see Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project [PubMed Abstract] [Full Text HTML]. Arch Gen Psychiatry. 2004 Jul;61(7):669-80.
The above article has been cited 41 PubMed Central articles. And the above article also has the following figure from The Texas Medication Algorithm Project:
