What are the treatment options for Major Depressive Disorder (MDD)?

From the Guidelines

Clinicians should select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient. This recommendation is based on a strong recommendation with moderate-quality evidence from the American College of Physicians guideline published in 2016 1.

Treatment Options

When considering treatment options for Major Depressive Disorder (MDD), it's essential to evaluate the effectiveness, potential harms, and patient preferences. The guideline evaluated various interventions, including psychotherapies, complementary and alternative medicines, exercise, and second-generation antidepressants. Key outcomes considered included response, remission, functional capacity, quality of life, reduction of suicidality or hospitalizations, and harms.

Medication and Psychotherapy

Some of the key treatment options for MDD include:

• Second-generation antidepressants, which are often prescribed as a first-line treatment
• Psychotherapies, such as cognitive behavioral therapy, which have strong evidence for effectiveness
• Lifestyle modifications, including regular exercise, good sleep hygiene, and social connection, which are important adjuncts to formal treatment

Individualized Treatment

Treatment should be individualized based on the patient's symptom profile, previous response to treatment, side effect tolerance, and patient preference. Clinicians should discuss treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient to determine the best course of treatment. As noted in the guideline, depressive disorders are a significant health care issue, resulting in substantial costs to society and health care systems 1.

Key Considerations

Some essential considerations when treating MDD include:

• The potential benefits and harms of different treatment options
• The importance of patient preference and involvement in the treatment decision-making process
• The need for ongoing monitoring and adjustment of treatment as needed to ensure optimal outcomes.

From the FDA Drug Label

Initial Treatment Dosage for Adults Major Depressive Disorder and Obsessive-Compulsive Disorder Sertraline treatment should be administered at a dose of 50 mg once daily. The recommended starting dose for MDD is 150 mg once daily in the morning. After 4 days of dosing, the dose may be increased to the target dose of 300 mg once daily in the morning.

The treatment options for Major Depressive Disorder (MDD) include:

• Sertraline: initial dose of 50 mg once daily, with possible increases up to 200 mg/day 2
• Bupropion: initial dose of 150 mg once daily, with possible increases to 300 mg once daily 3 Key points:
• Dose adjustments should be made to maintain patients on the lowest effective dose
• Patients should be periodically reassessed to determine the need for maintenance treatment
• The dose needed for maintenance treatment may not be identical to the dose needed to achieve an initial response

From the Research

Treatment Options for Major Depressive Disorder (MDD)

• The treatment options for MDD include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, paroxetine, and escitalopram 4, 5, 6, 7, 8
• SSRIs have been shown to be effective in the treatment of MDD, with response rates ranging from 50-60% 5, 7
• The combination of modafinil with an SSRI at treatment initiation may enhance the onset and degree of symptom benefit in patients with MDD and fatigue 4
• Higher starting doses of SSRIs may be associated with higher response rates, but also higher rates of discontinuation due to adverse events 5
• Sertraline has been shown to be effective and well-tolerated in the treatment of MDD in elderly patients, with a low potential for drug interactions 6
• Escitalopram has been shown to be effective in the prevention of recurrent depression, with maintenance treatment significantly reducing the risk of recurrence 8

SSRI Treatment

• Fluoxetine has a favorable tolerability profile and is as effective as tricyclic antidepressants in the treatment of MDD 7
• Sertraline is an effective and well-tolerated antidepressant for the treatment of MDD in patients aged ≥60 years, with a low potential for drug interactions 6
• Escitalopram has been shown to be effective in the treatment of MDD, with a significant reduction in the risk of recurrence with maintenance treatment 8

Combination Therapy

• The combination of modafinil with an SSRI at treatment initiation may be beneficial for patients with MDD and fatigue, with significant improvements in symptoms and fatigue 4