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Statement of Need/Overview:
Impact of Major Depressive Disorder (MDD) is profound in the United States, affecting almost 15 million American adults (6.7% of the population) in a given year.1 It is the #1 cause of disability in adults ages 15-44.2 A variety of antidepressant agents have been proven effective in the acute and long-term management of MDD. Despite advances in treatment, over one-third of persons with depression fail to achieve an adequate response to two respective antidepressant drug therapy attempts.3 Clinicians must understand the importance of achieving remission when treating this condition. Persons with MDD who achieve symptomatic remission experience greater improvement in functioning (and commensurate improvement in disability) than those who obtain some response without full remission.4 Treating only to response leaves the patient with residual symptoms and can lead to a greater risk for relapse and recurrence, more chronic depressive episodes, a shorter duration between episodes, and continued impairment in work and relationships.5-8 Newer studies have focused on neuroimaging markers, specifically reductions in hippocampal volume in patients with MDD, to assess the impact of short- and long-term treatment on various aspects of the disorder.9-19 One study demonstrated that decreased volume in the hippocampal head and tail are related to trait changes, whereas changes in the hippocampal body may be dependent on treatment.20 In addition, this study also demonstrated that long-term antidepressant treatment may actually have a neuroprotective effect on hippocampal volume in patients with MDD. There is also increased attention to the effects of depression and antidepressants on neurotrophins and, specifically, brain-derived neurotrophic factor (BDNF) as a marker for disease. Generally, there are four broad categories of treatment for patients who have experienced inadequate response to first-line antidepressants. These include 1) increasing the dose of the antidepressant, 2) switching to a different antidepressant, 3) augmenting the treatment regimen with a non-antidepressant agent, and 4) combining the initial antidepressant with a second antidepressant.21 Although these treatments should be based on individual strategies, each strategy has unique advantages and disadvantages. The greatest amount of evidence for switching antidepressants has focused on the use of newer agents such as SNRIs and other SSRIs.22,23 The STAR*D trial examined the differences in efficacy, safety and tolerability of different antidepressants for the treatment of MDD as well as adjunctive (combination) therapy, augmentation, or switching to a different agent altogether.24 The researchers found that with each successive step through the treatment regimen, more patients achieved symptom remission. 1Kessler RC, et al. Arch Gen Psychiatry. 2005. 2WHO. 2004. 3Nemeroff C, J Clin Psychiatry. 2007. 4Trivedi MH, et al. Int Clin Psychopharmacol. 2009. 5Judd LI, et al. Am J Psychiatry. 2000. 6Paykel ES, et al. Psychol Med. 1995. 7Thase ME, et al. Am J Psychiatry. 1992. 8Miller JW, et al. J Clin Psychiatry. 1998. 9Videbech P, et al. Am J Psychiatry. 2004. 10McKinnon MC, et al. J Psychiatry Neurosci. 2009. 11Posener JA, et al. Am J Psychiatry. 2003. 12Malykhin NV, et al. J Psychiatry Neurosci. 2010. 13Maller JJ, et al. Hippocampus. 2007. 14Neumeister A, et al. Biol Psychiatry. 2005. 15MacQueen GM, et al. Biol Psychiatry. 2008. 16Frodl T, et al. Am J Psychiatry. 2002. 17Lange C, Irle E. Psychol Med. 2004. 18de Geus EJ, et al. Biol Psychiatry. 2007. 19Hastings RS, et al. Neuropsychopharmacology. 2004. 20Malykhim NV, et al. J Psychiatry Neurosci. 2010. 21Papakostas GI. J Clin Psychiatry. 2009. 22Poirier MF, Boyer P. Br J Psychiatry. 1999. 23Lenox-Smith AJ, Jiang Q. Int Clin Psychopharmacol. 2008. 24Rush AJ, et al. Am J Psychiatry. 2006.
Target Audience
Psychiatric pharmacy specialists attending CPNP 2011.
Learning Objectives
At the conclusion of this application-based activity, participants will be able to:
Agenda
Accreditation
Statements of credit will be issued to those participants attending the activity and completing a CE request form and will be issued in 10 business days.
Faculty Disclosures and Biographical Sketches
In accordance with the Food and Drug Administration, the speakers have disclosed that there is the potential for discussions concerning off-label uses of a commercial product/device during this educational activity. Any person who may contribute to the content of this continuing education activity must disclose significant relationships (and any known relationships of their spouse/partner) with commercial companies whose products or services are discussed in educational presentations. Significant relationships include receiving from a commercial company research grants, consultant fees, travel, other benefits, or having a self-managed equity interest in a company. Disclosure of a relationship is not intended to suggest or condone any bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Leigh Anne Nelson, PharmD, BCPP (Activity Chair)Assistant Professor University of Missouri-Kansas City School of Pharmacy Division of Pharmacy Practice and Administration Kansas City, MO Dr. Nelson is an Assistant Professor in the School of Pharmacy at the University of Missouri-Kansas City (UMKC). She is a Board Certified Psychiatric Pharmacist. She obtained her BS and PharmD from UMKC. Dr. Nelson completed a pharmacy practice residency at Hamot Medical Center in Erie, Pennsylvania, a psychiatric pharmacy practice residency at the Capital District Psychiatric Center, and a psychiatric pharmacotherapy fellowship at the Albany College of Pharmacy in Albany, New York. She spent five years at St. Louis College of Pharmacy and St. Louis University School of Medicine and two years as a Medical Science Liaison with Bristol-Myers Squibb in the CNS therapeutic area before coming to UMKC in 2005. The Center for Behavioral Medicine in Kansas City, Missouri serves as her primary practice and teaching site for PharmD students and a PGY2 residency program. Dr. Nelson teaches psychopharmacology courses in both the Pharmacy and Medicine programs at UMKC. She is active in psychopharmacology research with interests in antipsychotic drug therapy, schizophrenia, and medication adherence. Dr. Nelson has disclosed that she receives grant/research support from Eli Lilly and Otsuka. Matthew A. Fuller, PharmD, BCPS, BCPP, FASHP Clinical Pharmacy Specialist, Psychiatry Louis Stokes Cleveland Department of Veterans Affairs Medical Center Brecksville, OH Clinical Associate Professor of Psychiatry Clinical Instructor of Psychology Case Western Reserve University Cleveland, OH Adjunct Associate Professor Clinical Pharmacy University of Toledo Toledo, OH Dr. Fuller received his BS in Pharmacy from Ohio Northern University and received his PharmD from the University of Cincinnati. He completed a residency in hospital pharmacy from Bethesda Hospital in Zanesville, Ohio. Following the completion of his training he joined the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Cleveland, Ohio. Dr. Fuller has over 25 years of experience as a pharmacist. His main practice site is acute in-patient psychiatry. Dr. Fuller is currently a Clinical Pharmacy Specialist in Psychiatry at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC). He is also an Associate Professor of Psychiatry and a Clinical Instructor of Psychology at Case Western Reserve University in Cleveland, an Adjunct Associate Professor of Clinical Pharmacy at the University of Toledo, and Director of an ASHP accredited PGY2 Psychiatric Pharmacy Residency Program. Dr. Fuller has received several awards including the Upjohn Excellence in Research Award and the OSHP Hospital Pharmacist of the Year Award in 1994. In 1996, he received the CSHP Evelyn Gray Scott Award (Pharmacist of the Year). In 2001, he received the OSHP Pharmacy Practice Research Award, and in 2003 he received an Outstanding Contribution Award from the VA Healthcare System of Ohio and a Certificate of Appreciation from The Japanese Society of Hospital Pharmacists. In 2007, Dr Fuller received an Outstanding Leadership Award from the College of Psychiatric and Neurologic Pharmacists, and in 2009 he received a Performance Award from the LSCDVAMC. Dr. Fuller is Board Certified in both Pharmacotherapy and Psychiatric Pharmacy and is an ASHP Fellow. He is a past President of the College of Psychiatric and Neurologic Pharmacists where he has also chaired and served as a member of the recertification committee and task force, residency and post graduate training committee, business development committee, foundation committee, nominations committee, and the VA task force. He has also chaired and been a planning committee member for the Midwest Neuropsychopharmacology Meeting. He is a member of local, state, and national pharmacy organizations and is active in scholarly pursuits. He has presented at local, state, national, and international venues. He serves as a reviewer for Archives of General Psychiatry, Acta Psychiatrica Scandinavica, Journal of Clinical Psychiatry, American Journal of Health-Systems Pharmacists, Progress in Neuro-Psychopharmacology & Biological Psychiatry, Savvy Psychopharmacology, Current Psychiatry, and is a member of the Editorial Board (Psychiatry) for The Annals of Pharmacotherapy. In 1998, Dr. Fuller joined Lexi-Comp's editorial advisory panel and is the author of two psychotropic drug information handbooks and a co-author of a drug interactions handbook. He currently remains involved with Lexi-Comp as an independent contractor. Dr. Fuller has indicated that he has nothing to disclose. Roger S. McIntyre, MD, FRCPC Head, Mood Disorders Psychopharmacology Unit University Health Network Associate Professor of Psychiatry & Pharmacology University of Toronto Toronto, ON Dr. McIntyre is currently an Associate Professor of Psychiatry and Pharmacology at the University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network, Toronto, Canada. He is involved in multiple research endeavors which primarily aim to characterize the association between mood disorders and medical comorbidity. This research involves elucidating metabolic adverse events associated with the use of psychotropic medications, the impact of medical comorbidity on the course of mood disorders, and the effect of glucose homeostasis on neurocognition. Dr. McIntyre is a contributor to the CPA guidelines for the treatment of depressive disorders and the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of bipolar disorder. He has published extensively in leading peer-reviewed journals and textbooks. Dr. McIntyre is also a reviewer for many journals including the American Journal of Health-System Pharmacy, Biological Psychiatry, Journal of Clinical Psychiatry, and The New England Journal of Medicine and serves as a grant reviewer for the National Institute of Mental Health. He completed his Medical Degree at Dalhousie University and did his psychiatry residency training and fellowship in psychiatric pharmacology at the University of Toronto. Dr. McIntyre has disclosed that he is a member of the speakers' bureaus for AstraZeneca, Biovail, Eli Lilly, Ortho-McNeil-Janssen, Lundbeck, and Wyeth. He receives grant/research support from Eli Lilly, Janssen, and Shire.
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Supported by an educational grant from  Presented by Creative Educational Concepts, Inc. 
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Creative Educational Concepts, Inc. (CEC) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity has
been assigned ACPE #0245-0000-11-002-L01-P and will award 1.5 contact hours (0.15 CEUs) of continuing pharmacy education credit. CEC complies with the Criteria for
Quality for continuing education programming.