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Evaluating and Managing Major Depression: Linking Assessment Measures and Outcomes in Light of the Black Box Warning

neuroscienceCME TV

Premiere Date: Wednesday, January 30, 2008

This activity offers CE credit for:

1. Physicians (ACCME/AMA PRA Category 1)
2. Nurses (CNE)
3. Pharmacists (ACPE)
4. Psychologists (APA)
5. Social Workers (NASW)

All other clinicians will either receive a CME Attendance Certificate or may choose any of the types of CE credit being offered.
Credit Expiration Date:
Friday, January 30, 2009

Faculty

MODERATOR: Madhukar H. Trivedi, MD Professor of Psychiatry Betty Jo Hay Distinguished Chair in Mental Health Lydia Bryant Test Professorship in Psychiatric Research Chief, Division of Mood Disorders NIMH Depression Trials Network Research Program Co-Principal Investigator University of Texas Southwestern Medical Center Dallas, TX

Thomas L. Campbell, MD William Rocktaschel Professor and Chair Department of Family Medicine University of Rochester School of Medicine & Dentistry Rochester, NY

Henry Chung, MD Clinical Associate Professor, Associate Vice President Student Health Department of Psychiatry New York University New York, NY

Maria A. Oquendo, MD Professor of Clinical Psychiatry Director of Clinical Studies, Department of Neuroscience NYS Psychiatric Institute and Columbia University New York, NY

Faculty Bios and Disclosure Declaration

Click here to view faculty bios and activity disclosures.

Statement of Need

Many people who are eventually diagnosed with Major Depressive Disorder (MDD) at first present to their primary care physician (PCP) with somatic complaints such as chronic pain, fatigue, sleep-related problems, sexual dysfunction, and weight gain or loss.(1) Screening instruments to identify such individuals can and should be administered in the primary care office as part of the initial medical questionnaire. These include the PHQ-9 symptom depression checklist and a tool to assess a common comorbid condition, alcohol abuse, that often negatively impacts long-term outcomes for depression.(2)

Studies that have followed PCP education programs on depression recognition and treatment have revealed that in the years when intervention programs were delivered, antidepressant prescriptions increased and suicide rates decreased.(3) Armed with assessment tools and knowledge, PCPs can disseminate this information to patients and engage them in the understanding of the etiology of their depression, diagnosis of their problems, and treatment choices and goals.(4) Management of depression includes both prescription medication and psychological intervention. The discussion on medication choice should bring to attention the benefits as well as possible short- and long-term adverse reactions and side effects.(4)

Since it is becoming clearer that depression is often a chronic and recurrent illness, follow-up care is vital. The Agency for Healthcare Research and Quality recommends that patients be seen at least once every two weeks until remission. Progress can be monitored both through PCP rating scales and patient take-home diaries, which can be used to reassess whether the current treatment is adequate or requires modification. Such monitoring can also assist with decisions about whether the patient should continue treatment under the PCP or be referred to a psychiatrist.(5) In this live, evidence-based, neuroscienceCME TV activity, the experts will explore the recognition and management of depression and the contribution to outcomes of education for both PCPs and patients. Easy-to-use measurement of clinical status and outcomes will be discussed.

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1. Kapfhammer H-P. Somatic symptoms in depression. Dialogue Clin Neuroscie 2006;6:227-239.
2. Wittkampf KA, Naeije L, Schene AH, Huyser J, van Weert HC. Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry 2007;29:388-395.
3. Henriksson S, Isacsson G. Increased antidepressant use and fewer suicides in Jämtland county, Sweden, after a primary care educational programme on the treatment of depression. Acta Psychiatr Scand 2006;114:159-167.
4. Wolf NJ, Hopko DR. Psychosocial and pharmacological interventions for depressed adults in primary care: A critical review. Clin Psychol Rev 2007 Apr 29;[Epub ahead of print].
5. Fochtmann LJ, Gelenberg AJ. Guideline watch: Practice guideline for the treatment of patients with major depressive disorder (2nd Ed). Focus: J Lifelong Learn Psych 2005;3:24-42.

Activity Goal

To recognize somatic symptoms that may underlie, but mask, a diagnosis of Major Depressive Disorder; to analyze the contribution of primary care physician education on reducing suicide rates by increasing levels of depression treatment, and to identify pharmaceutical and psychological measures to achieve depression remission.

Learning Objectives

At the end of this CE activity, participants should be able to:

• Identify presentation of somatic symptoms that could underlie a diagnosis of Major Depressive Disorder (MDD).
• Formulate appropriate treatment plans and goals for those diagnosed with MDD.
• Evaluate the usefulness of PCP education on the diagnosis and management of MDD.

Target Audience

Target audience includes physicians, physician assistants, nurse practitioners, nurses, psychologists, social workers, case managers, pharmacists, and other other healthcare professionals interested in the management and treatment of depression.

Credit Information

CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CME Outfitters, LLC, designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Note to Physician Assistants: AAPA accepts Category I credit from AOACCME, Prescribed credit from AAFP, and AMA Category I CME credit for the PRA from organizations accredited by ACCME.

CNE Credit (Nurses):
CME Outfitters, LLC, is an approved provider of continuing nursing education by the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

It has been assigned code 6WASUP-PRV-0621. 1.0 contact hours will be awarded upon successful completion.
Note to Nurse Practitioners: The content of this CNE activity pertains to Pharmacology.

CEP Credit (Psychologists):
CME Outfitters is approved by the American Psychological Association to sponsor continuing education for psychologists. CME Outfitters maintains responsibility for this program and its content. (1.0 CE credits)

NASW Credit (Social Workers):
This program was approved by the National Association of Social Workers (provider #886407722) for 1 continuing education contact hour.

CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 1.0 contact hours (0.1 CEUs)
Universal Program Number: 376-999-08-001-L04-P (live presentation) 376-999-08-001-H04-P (recorded programs)

Post-tests, credit request forms, and activity evaluations can be completed online at www.neuroscienceCME.com (click on the Testing/Certification link under the Activities tab - requires free account activation), and participants can print their certificate or statement of credit immediately (70% pass rate required). Otherwise, participants should fully complete and return both the credit request form and activity evaluation located within the course guide for this activity. A certificate or statement of credit will be mailed within 4-6 weeks to all who successfully complete these requirements.

Questions about this activity? Call us at 877.CME.PROS (877.263.7767).