Determining the Need for Antidepressant Medications

Determining the Need for Antidepressant Medications Overview
Prior to starting antidepressants you should discuss the potential benefits of non-pharmacological approaches to treatment. Non-pharmacological interventions alone may be helpful to minimize depressive symptoms and may make antidepressant treatment unnecessary.  They are also likely to be beneficial in combination with antidepressants should antidepressants become necessary.

Depression can present a wide array of signs and symptoms, the severity of which may change over time. In order to determine whether a patient requires antidepressants, you will need to consider the nature of the symptoms, their severity, their duration, and their impact. The following pages provide information on indications for antidepressant therapy based on your clinical assessment of the patient.

As a general rule, DSM-IV diagnostic criteria should be used to diagnose depression. However, in patients with hepatitis C, whether they are on or off interferon, it may be difficult to rely on neurovegetative symptoms to diagnose depression, since there is significant symptom overlap (for example, poor energy and sleep problems). Paying closer attention to the patient’s moods, anhedonia, and pessimistic attitudes can be more helpful when diagnosing depression in patients taking interferon.

Depression can present itself in a variety of ways. Some patients become slowly, but progressively, more irritable and depressed. Others quickly show acute signs, including depressed mood and/or suicide ideation. Because of this wide range of symptoms, each patient requires a unique treatment plan based on family history, patient history, observational data, clinical expertise, and judgment. There are specific screening tools designed to identify depressive symptoms, and these tools should be incorporated into each clinic visit. There may be times when a patient is experiencing mild depression, and appropriate supportive measures will alleviate symptoms. At other times, a patient may have such severe symptoms that he or she needs a referral to a mental health professional for management. The good news is that most patients can be treated safely and effectively in the hepatitis C clinic with both supportive and pharmacologic measures.