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CME
Treating Depressive Disorders
 
Psychotic Depression3
Level of Evidence Place in Therapy Medication Usual Daily Dose1 Cost per
Day2
Level I Evidence and generally tolerable side effect/safety profile. 1st choice Due to the nature of this condition, and the absence of placebo-controlled trials, there is insufficient Level I evidence to support our criteria for first choice intervention.
Level II evidence or Level I evidence but less tolerable side effect/safety profile. 2nd choice ELECTROCONVULSIVE THERAPY
ANTIDEPRESSANT (TCA OR SSRI) + ANTIPSYCHOTIC
Level III evidence or Level I/II evidence and significantly less tolerable side effect/safety profile. 3rd choice4 AMOXAPINE 150-300 mg $0.93-1.86
FLUOXETINE
(Prozac) 		20-40 mg $1.08-2.16
FLUVOXAMINE
(Luvox) 		100-200 mg $0.99-1.98
SERTRALINE
(Zoloft) 		50-150 mg $1.60-3.35

Psychotic depression, in our opinion, should warrent psychiatric referral. Optimal treatment of the disorder requires a shared care model on ogoing consultation between primary physician and consultant.

When considering the use of antipsychotics, physicians must factor in the risk of side effects such as tardive dyskinesia. Patients with mood disorders are at hight risk of devoloping tardive dyskinesia than patients with schizophrenia. Therefore, the use of the newer atypoical antipsychotics with mood enhancing effects (e.g., Risperidone orOlanzapine) may be considered, as the risk of tardive dyskinesia is suggested to be lower with these agents.

 

1. Usual daily doses are provided unless otherwise stated. Consult the drug monograph for details on age and condition specific dosing.
2. Approximate costs were derived from the ODB formulary (#36) or manufacturers' price lists and do not include professional fees or markups.
3. Reassess possibility of Bipolar Disorder.
4. Although there are published reports with these agents as monotherapies, the panel does not recommend single antidepressant treatment for the condition.

From: CANMAT - Guidelines for the Diagnosis and Pharmacological Treatment of Depression (1st Edition Rev., 1999) Page 26.

Back to Treating Depressive Disorders

Back to Managing Depressive Disorders - (Selections from: CANMAT - Guidelines for the Diagnosis and Pharmacological Treatment of Depression [1st Edition Rev., 1999])

 


Over one million Canadians suffer from some form of depressive illness.