Section - Video Lectures

05. Predictors of Remission, Partial Response, Switching Antidepressants, Side Effects, Drug–Drug Interactions, and CYP Polymorphism Testing

Published on February 1, 2021 Expired on April 1, 2025

Charles F. Reynolds III, M.D.

Editor, American Journal of Geriatric Psychiatry Distinguished Professor of Psychiatry emeritus - University of Pittsburgh School of Medicine

Key Points

Early improvement in the first 2 weeks is a reliable indicator of treatment response and remission.
Consider adding a second medication if there is a partial response or switching class if there is nonresponse.
Early improvement in the first 2 weeks is a reliable indicator of treatment response and remission.
Consider adding a second medication if there is a partial response or switching class if there is nonresponse.

To unlock this video you need to become a Bronze, Silver, Gold, Bronze extended, Silver extended or Gold extended Member.

Check Our CME Program

Downloads for Offline Access

Download Presentation File (PPTX)
Download Audio File (MP3)
Download Video (MP4)

Slides and Transcript

Slide 1 of 15

Let's delve a little bit deeper now into things like predictors of remission, partial response, prediction of the need to switch antidepressants, side effects, drug-drug interactions and cytochrome p450 polymorphism testing.

Predictors of Remission, Partial Response, Switching Antidepressants, Side Effects, Drug–Drug Interactions, and CYP Polymorphism Testing Slide 1 of 15

Slide 2 of 15

First, I'd like to emphasize that overall and this has been shown in various systematic reviews and meta-analyses that the response rate to acute phase pharmacotherapy in late-life depression versus placebo is about 44% among drug randomized participants versus about 35% among placebo randomized participants. This is from a very nice systematic review and meta-analysis done by Craig Nelson some years ago and his colleague, Lon Schneider at the University of Southern California. Craig and Lon calculated that the odds ratio for response to medication was about 1.4 with a 95% confidence interval of 1.2 to 1.6. Now, to be sure, the drug treatment was significantly better than pill placebo but only modestly so with a number needed to treat of about 13. Now, I would emphasize that randomized clinical trials are obviously not the same thing as practice and real-life settings and very often we have a sense in clinical practice that a particular agent is not working so we may choose to switch agents or to add a second agent long before clinical trial duration of the sort that Lon and Craig analyzed which is typically on the order of six to 12 weeks.

References:

Nelson, J. C., Delucchi, K., & Schneider, L. S. (2008). Efficacy of second generation antidepressants in late-life depression: A meta-analysis of the evidence. The American Journal of Geriatric Psychiatry, 16(7), 558-567.

Predictors of Remission, Partial Response, Switching Antidepressants, Side Effects, Drug–Drug Interactions, and CYP Polymorphism Testing Slide 2 of 15

Unlock this Video Lecture and earn 1.25 CMEs
Become a Bronze, Silver, Gold, Bronze extended, Silver extended or Gold extended Member.

Get Instant Access

Already have an account? Sign in

Next Section

06. Long-Term Treatment in Later-Life Depression: Maintenance, Adverse Effects, and Combination of Antidepressants and Donepezil

Learning Objectives:

After completing this activity, the learner will be able to:

Identify the consequences of major depression in later life and the importance of treatment.
Discuss the management of major depression in later life, including pharmacologic and nonpharmacologic treatments.
Describe the approaches to preventing depression.

Original Release Date: 02/01/2021

Review and Re-release Date: 03/01/2024

Expiration Date: 04/01/2025

Expert: Charles Reynolds, M.D.

Medical Editor: Lorena Rodriguez, M.D

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationship(s) to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:

Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
Download your certificate.

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 1.25 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.