Tuesday, June 05, 2012
DEPRESSION
on line 31-5-2012
Hello. This is Dr. Scott Irwin, Chief of Psychiatry and Psychosocial Services at San Diego Hospice and The Institute for Palliative Medicine. I'd like to talk to you about the rapid treatment of depression in patients who don't have time to wait for standard antidepressant therapy to work.
Depression is not a normal part of end of life. Only 15% of patients in hospice and palliative care settings have major depressive episodes. These episodes are treatable, and if we don't treat them, depression causes a tremendous amount of suffering -- not only for the patient but for families as well.
The way we treat depression [at the end of life] is with psychostimulants. We often use methylphenidate, and we'll start by giving 5 mg in the morning. If, in an hour, the patient hasn't had any effects that they don't like, we'll give them another dose 4 hours later. As long as we are continuing to get benefit and no side effects, we'll continue to increase the dose; so the next day, we might go to 10 mg and 10 mg [later in the day], and the day after that, 15 mg and 15 mg [in a second daily dose]. We rarely see doses effective over 20 mg twice a day. In the home setting, we might go a little slower and increase the dose every 5-7 days instead.
We see very few side effects. We don't see tolerance, and you might actually get some adjunct analgesia as well.
So, if you have somebody who's depressed and they don't have time to wait for standard antidepressant therapies to work, think of using psychostimulants and titrate them effectively, safely, and rapidly. Be sure to treat depression so that we can relieve suffering in both patients and their families.
Thank you for listening. This is Dr. Scott Irwin, Chief of Psychiatry and Psychosocial Services at San Diego Hospice and The Institute for Palliative Medicine.
on line 31-5-2012
Hello. This is Dr. Scott Irwin, Chief of Psychiatry and Psychosocial Services at San Diego Hospice and The Institute for Palliative Medicine. I'd like to talk to you about the rapid treatment of depression in patients who don't have time to wait for standard antidepressant therapy to work.
Depression is not a normal part of end of life. Only 15% of patients in hospice and palliative care settings have major depressive episodes. These episodes are treatable, and if we don't treat them, depression causes a tremendous amount of suffering -- not only for the patient but for families as well.
The way we treat depression [at the end of life] is with psychostimulants. We often use methylphenidate, and we'll start by giving 5 mg in the morning. If, in an hour, the patient hasn't had any effects that they don't like, we'll give them another dose 4 hours later. As long as we are continuing to get benefit and no side effects, we'll continue to increase the dose; so the next day, we might go to 10 mg and 10 mg [later in the day], and the day after that, 15 mg and 15 mg [in a second daily dose]. We rarely see doses effective over 20 mg twice a day. In the home setting, we might go a little slower and increase the dose every 5-7 days instead.
We see very few side effects. We don't see tolerance, and you might actually get some adjunct analgesia as well.
So, if you have somebody who's depressed and they don't have time to wait for standard antidepressant therapies to work, think of using psychostimulants and titrate them effectively, safely, and rapidly. Be sure to treat depression so that we can relieve suffering in both patients and their families.
Thank you for listening. This is Dr. Scott Irwin, Chief of Psychiatry and Psychosocial Services at San Diego Hospice and The Institute for Palliative Medicine.
# posted by roodbont @ 11:39 PM 
