Clinical Dialogue: Managing Depression After Initial Treatment: A Review of Next Steps in Major Depressive Disorder
Major depressive disorder (MDD) remains a top cause of disability worldwide and in the United States. In the U.S., roughly one in six people will have at least one episode of MDD over their lives. When combined with chronic medical conditions, as it frequently is, MDD is responsible for a 60-80% mortality increase. PAs and other providers in primary care hold a foundational role in managing depression. Some international estimates place the prevalence of MDD in primary care at roughly 20%. In the U.S., the majority of ambulatory care visits for depression continue to be through primary care providers. The reasons for the reliance on primary care to manage MDD are potentially manifold. These include difficulty in receiving psychiatrist-mediated care, stigma associated with seeing a psychiatrist, or having a relatively mild depression that is more appropriate for primary provider care. PAs hold a key place in managing depression in the U.S. As such, care of patients with depression can be improved by increased PA training in the ongoing assessment and follow-up management of MDD. This activity will strengthen PAs’ clinical acumen in treating the large numbers of depressed patients in the U.S.
Learning ObjectivesAt the conclusion of this activity, the PA should be better able to:
- Implement validated depression measurement scales in the primary care setting.
- Identify patients with suboptimal response and choose among evidence-based strategies for medication switching and augmentation.
- Outline new and emerging medications for MDD with a foundational understanding of their mechanisms of action.