Gus Alba, MD, DFAPA: Let’s move on to another subject. I would like you both to discuss the difference in time to achieve a goal or response with different classes of treatment for major depressive disorder. What are the benefits of rapid symptom resolution?
Charles Montano, M.D.: I just started using nasal drops. If someone is really slandering I feel like they are giving up, this is too long, I can’t go on with this, I have horrible thoughts that I don’t want to wake up in the morning but I I will not kill myself—you must always seek it out. When these symptoms are quickly cleared, they can breathe clean air and say, “I have hope that I can get out from under this blanket of depression.”That’s the beauty of immediacy [antidepressants]Even some of the neurosteroids that are newer GABA glutamate preparations are very rapid and it’s very nice to see them in clinical studies. They would be a great addition. bottom. New Mechanisms; Better and Faster Ways to Reach Networks Implicated in Depression. Their quick response gives us hope. It revitalizes life.
Gus Alba, MD, DFAPA: The flip side of not getting a quick effect can be the risk of suicide, non-adherence to treatment, more spending, and a greater disease burden.
Charles Montano, M.D.: [Patients need] Early intervention and rapid follow-up. Do not wait a month after taking antidepressants. The only reason these people are on meds is because they believe in you and the system he calls once a week and at most he’ll be back in two weeks It is better to Data show that if the initial antidepressant works well in the long term, there is some improvement.
Gus Alba, MD, DFAPA: Carmen, how do you treat a patient who relapses after stopping treatment for major depressive disorder? Do you go back to the same treatment as before or choose a new one?
Carmen Kosicek, MSN, PMHNP-BC: First, what was it? Was it a side effect of the medicine? Have they changed insurance? why did they stop? Were they too flat? What is the reason? Maybe they will say I just forgot. ” I then reflect what I know from research in the 1990s. That is, the more you switch from drug to drug, the less likely you are to benefit. But that’s not what I usually see.what usually [individuals say] It means, “If you stop taking it because it worked, it won’t work anymore.” It wasn’t just a matter of changing insurance or forgetting to buy it. Turns out there was a problem with what they were taking. It could have been all sorts of adverse effects, weight gain, frequency of medication, sexual dysfunction, etc. It gives you a reason to help.
When individuals come to me, not everyone wants to change their meds when they first see me. But as Charles said, that OK might be 6. It’s no different than my phone. This is not the latest iPhone, but I like the camera, so I upgraded this one. From day one, I let my patients know that I was with them. I’m glad you got his 6. But if you want to be 8 or 10, tell me what’s there. It’s still a depression drug, but that’s why I like this over it. I encourage them to visit the website and look at the data of hundreds of other individuals like them. Some people say, “I want to upgrade my medicine like I upgraded my phone.” For others, it takes a little longer. When they come back in this episode, it’s chronic. I say Try it. “That’s how I treat my patients. I’m not here to force them into arms and say, ‘You have to change this.’ Must be mixed. that’s not what i do. I present the data and let them choose.
Gus Alba, MD, DFAPA: And you give them a choice.
Carmen Kosicek, MSN, PMHNP-BC: I’m going to give them a choice, but I’m not going to give them the choice that something is wrong. I say [options]” At the same time, it is not the only option. “[I say] There are various options here. That’s why I choose this one over that one. Here is my opinion. This is what I do for a living and why I choose this. ” Because if you are not prepared, it will not work.
Edited transcript for clarity