Depression (major depressive disorder, or MDD) was the leading cause of disability worldwide in 2017. In 2015, 7-10% of adults and 10-12% of adolescents in the US suffered from MDD. Alarmingly, suicide completion rates in the US increased 24% from 1999 to 2014.5 In 2015, suicide was the second leading cause of death in 15-34 year olds and the third leading cause of death in 10-14 year olds. Depression is also a known contributor to the illness and death associated with chronic pain and diseases such as dementia, diabetes, and cerebrovascular and heart disease. Depression should be treated along with chronic medical problems to achieve the best outcome for all conditions.
Both the Agency for Healthcare Research and Quality (AHRQ) and the National Institute for Mental Health (NIMH) recommend psychotherapy and antidepressants as effective treatments for depression. Adding certain antipsychotics to antidepressant therapy may boost the response to antidepressants. There is increasing evidence that exercise, a healthy diet, and certain supplements (eg, omega-3, vitamin D, folate, SAM-e) also decrease depressive symptoms. Electroconvulsive therapy (ECT) and other types of brain stimulation are FDA-approved and recommended for treatment-resistant depression. Ketamine is being investigated for treatment-refractory depression, and is currently being used (off-label) for some treatment-refractory cases…
Julie Dopheide, PharmD, BCPP, FASHP is Professor of Clinical Pharmacy, Psychiatry and the Behavioral Sciences at the University of Southern California School of Pharmacy and Keck School of Medicine in Los Angeles, CA. She is also the PGY2 psychiatric pharmacy residency program director and the director of pharmacy continuing education at the USC School of Pharmacy.