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An algorithm for the pharmacotherapy of depression

Posted by SD on May 3, 2000, at 19:32:31

In reply to no medicine works for me, help!, posted by Bonnie on May 2, 2000, at 23:23:32

http://www.mhc.com/Algorithms/Depression/index.htm

It starts at the above URL.
It is by David N. Osser, M.D.

Associate Professor of Psychiatry
Harvard Medical School

Basically it shows a recommended decision process for determining the order of meds to try for treating a depressed person. My experience is that the advice of most shrinks/psychopharmacologists will closely mirror this algorithm, including a rather limited use of combinations of meds and relegation of MAO inhibitors to 'third class' status.
I can't help thinking the under-use of combinations is wrong-headed because when I read on the web or a usenet newsgroup a personal account of someone finding a 90%+ cure after no luck with the first two or three meds, it is almost two or more meds together.

On the other hand, the value of combinations may be particularly common in the case of multiple disorders (comorbidity) or a single disorder other than a depressive one, neither of which this algorithm covers.

peace and health,

SD


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