Overview

Individuals with major depressive disorder (MDD) experiencing an incomplete response to initial antidepressant monotherapy can suffer functional impairment and poor clinical outcomes. The interactive, branching activity provides you with an opportunity to assess such a patient and make management decisions over multiple visits in a primary care setting.

By the end of this complex case, you will be better equipped to recognize when a patient would benefit from treatment advancement and will understand the patient and pharmacologic factors involved in individualizing treatment escalation, including how and when to employ combination antidepressant therapy or augmentation with a second-generation antipsychotic agent.

Learning Objectives

  1. Discuss benefits of early intervention for patients with major depressive disorder (MDD) who have not responded fully to treatment
  2. Identify patients with a partial response to therapy so that prompt treatment advancement can be implemented
  3. Examine evidence-based strategies to advance pharmacotherapy, including adjunctive therapy with a second-generation antipsychotic medication
  4. Formulate individualized plans for treatment advancement in patients with MDD experiencing a partial response to monotherapy
     

Faculty

Marlene Freeman

Professor of Psychiatry, Harvard Medical School
Associate Director, Ammon-Pinizzotto Center for Women’s Mental Health
Medical Director, Clinical Trials Network and Institute
Massachusetts General Hospital
Boston, MA

Disclosures

The following financial relationships have been disclosed by faculty.  All relevant relationships have been mitigated by Pri-Med Institute: 

Advisory Boards: Eliem, Sage

Independent Data Safety and Monitoring Committee: Janssen (Johnson & Johnson), Neurocrine, Novartis
Investigator Initiated Trials/Research: JayMac, Sage

Dr. Freeman is an employee of Massachusetts General Hospital and works with the MGH National Pregnancy Registry. MGH National Pregnancy Registry: Current Sponsors: Alkermes, Inc. (2016-Present); Aurobindo Pharma (2020-Present); AuroMedics Pharma LLC (2021-present); Johnson & Johnson/Janssen Pharmaceuticals, Inc (2019-Present); Otsuka America Pharmaceutical, Inc. (2008-Present); Sage Therapeutics (2019-Present); Sunovion Pharmaceuticals, Inc. (2011-Present); Supernus Pharmaceuticals (2021-Present); Teva Pharmaceutical Industries Ltd. (2018-Present).Past Sponsors: Forest/Actavis/Allergan (2016-2018, declined to sponsor: 2018-Present), AstraZeneca Pharmaceuticals (2009-2014, declined to sponsor: 2014-Present); Ortho-McNeil-Janssen Pharmaceuticals, Inc (2009-2014, declined to sponsor: 2015-Present); Pfizer, Inc. (2009-2011, declined to sponsor: 2012-Present). As an employee of MGH, Dr. Freeman works with the MGH CTNI, which has had research funding from multiple pharmaceutical companies and NIMH.

Scale Royalties through MGH

Scale, The Massachusetts General Hospital Female Reproductive Lifecycle and Hormones Questionnaire (Freeman et al. 2013)

Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose.


CME Information

AMA PRA Category 1 Credits

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 (ACCME) through the joint providership of Pri-Med Institute and Mental Health America, Inc. Pri-Med Institute is accredited by the ACCME to provide continuing medical education for physicians.


Designation Statement

Pri-Med Institute designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP

Accreditation Statement

This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners® (AANP) through the joint providership of Pri-Med Institute and Mental Health America, Inc. Pri-Med Institute is accredited by the AANP as an approved provider of nurse practitioner continuing education. Provider Number 040308.


Designation Statement

This activity is approved for 0.50 contact hour of continuing education, which includes 0.25 hours of pharmacology.

Instructions for Obtaining Credit

Once you have completed the activity, please click the "next" button to advance to the post-activity assessment. To complete this activity and claim credit, you must answer 2 out of the 3 questions correctly. If you are not successful after your first attempt, you will be given an opportunity to reflect upon the answer rationales and have the opportunity to review the educational content before proceeding. Once you have selected your answers, click the "submit" button to complete the evaluation questions and proceed to the claim credit screen.

MOC Credit Information

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 Medical Knowledge MOC point in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. 


Commercial Supporter

Supported by an educational grant from Otsuka America Pharmaceutical, Inc. and Lundbeck

Education Partner

Pri-Med Institute

Mental Health America, Inc.


Fine Print

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The opinions, ideas, and recommendations expressed in this educational activity are those of the faculty only and are not necessarily endorsed by, nor do they necessarily reflect, those of their affiliated institutions, Pri-Med Institute, Pri-Med Institute Advisory Boards and Consultants, DBC Pri-Med, LLC, or commercial supporters.

Clinical judgment must guide each clinician in weighing the possible risks, benefits, or contraindications of any diagnostics, interventions or treatments discussed. Clinicians should review manufacturers’ product information and consider these with the recommendations of other authorities when applying the assessment and/or clinical management strategies discussed in this activity to the care of their patients.

Pri-Med Institute educational activities are developed and conducted in accordance with the ACCME's Essential Areas and Policies. It is the mission of pmiCME to develop and present educational activities that are timely, fair-balanced, scientifically rigorous, and that serve to improve patient outcomes. To that end, we welcome your comments about how to better serve your needs.

Pri-Med Institute Accredited Provider
Pri-Med programs are owned and operated by DBC Pri-Med, LLC, a division of Diversified Communications, Inc. Pri-Med Institute, the accredited division of Pri-Med, is accredited with commendation by the ACCME and approved as a provider of continuing education by the AANP. Pri-Med Institute is the accredited provider for this activity.

Disclosures and Conflict of Interest
Pri-Med Institute requires all individuals in a position to influence educational content for Pri-Med Institute-certified CME activities to disclose relevant personal financial relationships with commercial interests prior to contributing to its educational activities. Pri-Med Institute assesses disclosed relationships and follows a defined process to resolve real or implied conflicts to ensure, to the best of its ability, that all educational content is free of commercial bias. Financial disclosures are listed in the activity syllabus and will also be printed on the slides and announced at the start of each presentation.

Discussion of Off-Label Uses and Investigational Products
During the course of their presentations, the faculty may mention uses of products that have not been approved in the United States for the indication(s) being discussed. All presenters are instructed to notify participants when they are discussing unapproved uses or investigational agents. In addition, specific slides will include notation of the off-label use or investigational agent being discussed. Views presented related to unapproved uses of products are solely those of the presenter(s) and are not endorsed by Pri-Med Institute or DBC Pri-Med, LLC.

Questions? If you have questions about this activity, please email support@pri-med.com or call (877) 477-4633.