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Showing posts with the label treatment

Treatment of Psychotic Depression

Cochrane Review 2015(Wijkstra J 2015) Psychotic depression is heavily understudied, limiting confidence in the conclusions drawn. Evidence suggests that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or a placebo. Evidence for treatment with an antidepressant alone or for an antipsychotic alone is lacking. Maudsley Prescribing Guidelines 2018(Taylor 2018) Tricyclic augmented by olanzapine or quetiapine as the first line If tricyclic is not well tolerated, use SSRI or SNRI instead NICE For people who have depression with psychotic symptoms, consider augmenting the current treatment plan with antipsychotic medication (although the optimum dose and duration of treatment are unknown). CANMAT 2016 Use antipsychotic and antidepressant cotreatment (Level 1 evidence) APA Practice Guidelines for Major Depressive Disorder, 2010 For patients who exhibit psychotic symptoms during an episode of major depressive disorder, treatme

Vignette: Most Effective Treatment for a Man with Sudden Episodes of Anxiety

Vignette: Most Effective Treatment for a Man with Sudden Episodes of Anxiety A 30-year-old man presented with episodes of sudden anxiety, palpitations, chest tightness, and a feeling of impending doom. These episodes occur about 4-5 times per month for the last 7 months and last about 10 minutes on average. They have carried his physical examination and laboratory evaluation out, which is inconclusive about biological causation for his condition.  What would be the most effective treatment option? Cognitive therapy  Fluoxetine Imipramine Amitriptyline  Cognitive Behavior Therapy Controlled studies have shown that cognitive therapy is at least as effective as antidepressant medication in the treatment of the panic disorder (Mitte, 2005). Combined treatment with medication and psychotherapy may cause a better response in the acute phase than either treatment modality given alone, but probably not in the longer term. In the longer-term medication alone may have a less good outcome th