Table 1.
Messages delivered during detailing session
|
Phase I |
Treatment-resistant Depression in the Primary Care Setting |
| · Formulate a treatment plan at the start of therapy | |
| · Prior to switching or augmenting an antidepressant consider a longer trial (12–14 weeks) at a therapeutic dose | |
| · Triiodothyronine (T3, cytomel) is an effective and well tolerated augmentation agent | |
|
Use of Atypical Antipsychotics in Treatment –resistant Depression | |
| · Consider T3 (or lithium) prior to considering atypical antipsychotic augmentation agent | |
| · Atypical antipsychotics are associated with metabolic abnormalities and require regular monitoring | |
| Phase II |
Pharmacotherapy options for Insomnia |
| · Cognitive behavior therapy and pharmacologic treatment approaches have similar effectiveness | |
| · All sedative/hypnotics appear to be comparable in treating insomnia | |
| · Clinical data regarding sedating antidepressants and antipsychotics are lacking | |
|
Clinical use and comparative effectiveness of benzodiazepines | |
| · Long-term benzodiazepine use is rarely warranted | |
| · Withdrawal of benzodiazepine has led to improvements in cognitive functioning, balance, and memory without worsening insomnia (particularly in frail elderly) | |
| · Discontinuation should always include gradual tapering |