Depression: Equal-opportunity illness

Julie Dopheide, PharmD, associate professor of clinical pharmacy at the University of Southern California, describes treatment options for major depression here.

Dr. Dopheide discusses her own clinical experiences, data from various studies, and tips for preventing relapses and information on the treatment of suicidal, depressed patients.

"Just like cancer is an equal-opportunity illness, so is depression," she says. "There are all kinds of risk factors that play a role." Some of the examples of risk factors range from smoking to simply being a woman. DNA and environment also play a role in depression.

She also reviews tools for assessing depression in children and adolescents, explaining that five of the nine possible symptoms must be present for only two weeks to meet the existing requirements for diagnosis. Among some of those possible nine symptoms were a decreased interest or pleasure in things, sleep disturbances and depressed mood.

Selective serotonin reuptake inhibitors, or SSRIs are the first-line against depression, she explains. But it's important for psychiatrists, other physicians, and pharmacists to work together to monitor the behavior of a patient on these medications. Side-effect management, suicide assessment, and drug interaction screening are some of the important tasks to undertake after a medication is determined to treat depression.

SSRIs are usually the first option for treating major depression. But if an SSRI isn't working after a few trials, the depression could be resistant to medications, especially in adolescents. Dr. Dopheide cautions that teens or adolescents more often than ever want instant gratification.

"Just the other day I had girls saying they want a drug that 'won't make me fat and won't make me tired.'" But they need to be reminded to give the medication some time and let it do its job, she says. If a medication really is resistant, she recommends venlafaxine with close monitoring.

"Assessment about every one to three months even after remission is really important," she adds. "It can really help to prevent the major depression from coming back. We also need to recognize that we'll have fewer relapses if we medicate to cure the illness."