Diagnosis of Depression

●  What are some of the unique challenges facing primary care physicians in making an accurate diagnosis and in the management of depression?

●  How do you convince the patient who presents with somatic or headache pain that they may be suffering from symptoms of depression?

Management of Depression

●  What are the key changes that have taken place in the management of depression over the past 30 years?

●  What are some of the barriers for effective management of depression in the primary care setting?

●  What measurement tool can be used by primary care physicians to determine the effectiveness of their treatment of patients with depression?

●  How long do you treat with antidepressant agents before you modify your therapy?

●  How long should the acute phase of depression treatment be to reach remission in patients?

●  How does the primary care physician deal with the challenge of poor adherence to antidepressant therapy given the early onset of side effects of some antidepressant medications?

●  How long should the physician wait before seeing a response to the antidepressant drug before a decision is made that the drug is not working?

●  Why is reaching remission considered the gold standard for depression treatment?

●  When should the patient, who has achieved remission and is now on maintenance therapy, be allowed to discontinue medication?

●  What is the approach to depression management in the pregnant patient already on an SSRI?

●  What are the best predictors of depression relapse?

●  What is the role of the atypical antipsychotics in the treatment of depression?

Evidence-based Treatments/STAR*D Clinical Trial

●  What is STAR*D and how does that study assist primary care physicians in the treatment of depression?

●  What do the results of the STAR*D trial tell about the initial treatment of depression?

●  What did STAR* D show us about switching antidepressant agents and augmentation therapy?

●  What has been learned over the past 30 years of treating depression and what has the STAR*D contributed to our understanding?

●  What are take home messages from the STAR*D for primary care physicians?

Decisions to Refer

●  When should a primary care physician consider referral?

●  What are some of the challenges faced by the PCP when referring?

Addressing the Risk of Suicidality

●  What are the issues faced by physicians regarding FDA warnings on the risk of suicidality involved with the use of anti-depressants?

●  Are there particular risk factors for suicide in the depressed patient that the physician should consider?

Psychotherapy

●  What is the evidence supporting the effectiveness of psychotherapy?

●  What did the STAR*D trial demonstrate regarding the effectiveness of cognitive behavioral therapy?

●  In patients in remission for depression, can the addition of cognitive behavioral therapy reduce the risk of recurrence of depression following discontinuation of medication?

Bipolar Disorder

●  How does the potential for bipolar disorder affect the approach to management of major depressive disorder?

Collaborative Care and Chronic Disease Models for Depression

●  What is the collaborative care model as it applies to depression?

●  What is the chronic disease model for depression?