Evaluating and Managing Major Depression: Linking Assessment Measures and Outcomes in Light of the Black Box Warning
neuroscienceCME TV
Premiere Date: Wednesday, January 30, 2008This activity offers CE credit for:
- Physicians (ACCME/AMA PRA Category 1)
- Nurses (CNE)
- Pharmacists (ACPE)
- Psychologists (APA)
- Social Workers (NASW)
All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Credit™
Credit Expiration Date:
Friday, January 30, 2009
Note: Credit Is No Longer Available
 | Madhukar H. Trivedi, MD Professor of Psychiatry Betty Jo Hay Distinguished Chair in Mental Health University of Texas Southwestern Medical Center Dallas, TX |
 | Thomas L. Campbell, MD William Rocktaschel Professor and Chair Department of Family Medicine University of Rochester School of Medicine & Dentistry Rochester, NY |
 | Henry Chung, MD Clinical Associate Professor, Associate Vice President Student Health Department of Psychiatry New York University New York, NY |
 | Maria A. Oquendo, MD Chair and Ruth Ruth Meltzer Professor of Psychiatry Department of Psychiatry Perelman School of Medicine University of Pennsylvania Philadelphia, PA |
Many people who are eventually diagnosed with Major Depressive Disorder (MDD) at first present to their primary care physician
(PCP) with somatic complaints such as chronic pain, fatigue, sleep-related problems, sexual dysfunction, and weight gain or
loss.(1) Screening instruments to identify such individuals can and should be administered in the primary care office as part of the
initial medical questionnaire. These include the PHQ-9 symptom depression checklist and a tool to assess a common comorbid
condition, alcohol abuse, that often negatively impacts long-term outcomes for depression.(2)
Studies that have followed PCP education programs on depression recognition and treatment have revealed that in the years
when intervention programs were delivered, antidepressant prescriptions increased and suicide rates decreased.(3) Armed with
assessment tools and knowledge, PCPs can disseminate this information to patients and engage them in the understanding
of the etiology of their depression, diagnosis of their problems, and treatment choices and goals.(4) Management of depression
includes both prescription medication and psychological intervention. The discussion on medication choice should bring to
attention the benefits as well as possible short- and long-term adverse reactions and side effects.(4)
Since it is becoming clearer that depression is often a chronic and recurrent illness, follow-up care is vital. The Agency for
Healthcare Research and Quality recommends that patients be seen at least once every two weeks until remission. Progress can
be monitored both through PCP rating scales and patient take-home diaries, which can be used to reassess whether the current
treatment is adequate or requires modification. Such monitoring can also assist with decisions about whether the patient should
continue treatment under the PCP or be referred to a psychiatrist.(5) In this live, evidence-based, neuroscienceCME TV activity, the
experts will explore the recognition and management of depression and the contribution to outcomes of education for both
PCPs and patients. Easy-to-use measurement of clinical status and outcomes will be discussed.
- Kapfhammer H-P. Somatic symptoms in depression. Dialogue Clin Neuroscie 2006;6:227-239.
- Wittkampf KA, Naeije L, Schene AH, Huyser J, van Weert HC. Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry 2007;29:388-395.
- Henriksson S, Isacsson G. Increased antidepressant use and fewer suicides in Jämtland county, Sweden, after a primary care educational programme on the treatment of depression. Acta Psychiatr Scand 2006;114:159-167.
- Wolf NJ, Hopko DR. Psychosocial and pharmacological interventions for depressed adults in primary care: A critical review. Clin Psychol Rev 2007 Apr 29;[Epub ahead of print].
- Fochtmann LJ, Gelenberg AJ. Guideline watch: Practice guideline for the treatment of patients with major depressive disorder (2nd Ed). Focus: J Lifelong Learn Psych 2005;3:24-42.
To recognize somatic symptoms that may underlie, but mask, a diagnosis of Major Depressive Disorder; to analyze the contribution of primary care physician education on reducing suicide rates by increasing levels of depression treatment, and to identify pharmaceutical and psychological measures to achieve depression remission.
At the end of this CE activity, participants should be able to:
- Identify presentation of somatic symptoms that could underlie a diagnosis of Major Depressive Disorder (MDD).
- Formulate appropriate treatment plans and goals for those diagnosed with MDD.
- Evaluate the usefulness of PCP education on the diagnosis and management of MDD.
This continuing education activity is jointly sponsored by CME Outfitters, LLC, and the American Foundation for Suicide Prevention (www.afsp.org). The joint sponsors gratefully acknowledge financial support for this CE activity from the New York State Office of Mental Health.
Target audience includes physicians, physician assistants, nurse practitioners, nurses, psychologists, social workers, case managers, pharmacists, and other other healthcare professionals interested in the management and treatment of depression.
CME Credit (Physicians):
CME Outfitters, LLC, is accredited
by the Accreditation Council for Continuing
Medical Education to provide continuing
medical education for physicians.
CME Outfitters, LLC, designates this educational activity for
a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians
should only claim credit commensurate with the extent of
their participation in the activity.
CNE Credit (Nurses):
CME Outfitters, LLC, is an approved
provider of continuing nursing education by the New York
State Nurses Association, an accredited approver by the
American Nurses Credentialing Center’s Commission on
Accreditation.
It has been assigned code 6WASUP-PRV-0621. 1.0 contact
hours will be awarded upon successful completion.
Note to Nurse Practitioners: The content of this CNE activity pertains to Pharmacology.
CEP Credit (Psychologists):
CME Outfitters is approved
by the American Psychological Association to sponsor
continuing education for psychologists. CME Outfitters
maintains responsibility for this program and its content.
(1.0 CE credits)
NASW Credit (Social Workers):
This program was approved
by the National Association of Social Workers (provider
#886407722) for 1 continuing education contact hour.
CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 1.0 contact hours (0.1 CEUs)
Universal Program Number: 376-999-08-001-L04-P (live presentation) 376-999-08-001-H04-P (recorded programs)
Post-tests, credit request forms, and activity evaluations can be completed online at www.neuroscienceCME.com (click on the Testing/Certification link under the Activities tab - requires free account activation), and participants can print their certificate or statement of credit immediately (70% pass rate required). Otherwise, participants should fully complete and return both the credit request form and activity evaluation located within the course guide for this activity. A certificate or statement of credit will be mailed within 4-6 weeks to all who successfully complete these requirements.
Thomas L. Campbell, MD
Dr. Campbell is the William Rocktaschel Professor and Chair of Family Medicine and the Associate Director of the University of
Rochester Medical Center’s Center for Primary Care. Dr. Campbell received his medical degree at Harvard Medical School in 1979.
He completed his residency in family medicine and fellowship in family medicine and psychiatry at the University of Rochester in
1982 and 1984, respectively.
Dr. Campbell has published over 100 books, book chapters, original papers, book reviews, newsletters, editorials, and letters. He
has also presented at several professional meetings since 1984. Dr. Campbell currently serves on the editorial board for Qualitative
Studies on Health and Well-Being, Psychotherapy: Theory, Research, Practice, Training, and the Journal of Family Psychology.
Henry Chung, MD
Dr. Chung is Executive Director for the Student Health Center and Associate Vice President for Student Health at New York
University. He is also Clinical Associate Professor of Psychiatry at New York University School of Medicine.
Dr. Chung has a track record of leadership and achievement in strategic planning, community health, disease management
and research in both primary care and behavioral health settings. He has performed research and published articles related to
the integration of mental health treatment in primary care, especially for racial and ethnic minorities. In this regard, he was the
Founder and Project Director of the Asian American Primary Care and Mental Health “Bridge” Program, a nationally recognized
model program for primary care and mental health integration for racial and ethnic minorities. He has been widely recognized
for this work as a winner of the Bureau of Primary Health Care Models That Work competition in 2000, which selected the Bridge
Program for model replication.
Currently, he is leading a groundbreaking Regional College Health Initiative for the Collaborative Care of Depression – “College
Breakthrough Series” 2006-2008 funded by the Aetna Foundation and the New York Community Trust. From 2003-2005, he was
the Mental Health Research Core Leader at the newly created NYU Center for the Study of Asian American Health where he
currently remains a co-Principal Investigator. Since 2003, he has also been Co-Principal Investigator of the National Depression
Leadership Initiative which is jointly sponsored by the American Psychiatric Association, American Academy of Family Physicians
and the American College of Physicians. He is also a Board Member of the American Psychiatric Foundation of the American
Psychiatric Association.
Maria A. Oquendo, MD
Dr. Oquendo is Professor of Clinical Psychiatry at Columbia University and Vice-Chair for Education in the Department of
Psychiatry at Columbia University and the New York State Psychiatric Institute (NYSPI). She is also Director of the Clinical
Evaluation Core of the Silvio O. Conte Center for the Neurobiology of Mental Disorders at NYSPI. Her areas of expertise include the
diagnosis, pharmacologic treatment and neurobiology of Bipolar Disorder and Major Depression, with a special focus on suicidal
behavior as well as Cross Cultural Psychiatry.
Dr. Oquendo graduated summa cum laude and Phi Beta Kappa from Tufts University in 1980. She received her MD from the
College of Physicians and Surgeons at Columbia University in 1984. She completed her residency in Psychiatry at the Payne
Whitney Psychiatric Clinic in the New York Hospital-Cornell Medical Center.
Dr. Oquendo is the principal investigator on a high-risk study of suicide attempters with Bipolar Disorder and on a prospective
study of suicidal behavior in patients with affective and psychotic disorders. She is also a co-investigator on four other NIMH-funded
research studies examining the neurobiology of suicidal behavior. She is the Co-Principal Investigator on a Developing
Center for Interventions to Prevent Suicide. She is the recipient of a grant from the American Foundation for Suicide Prevention
for the study of serotonin transporter binding using PET in bipolar suicide attempters, non-attempters, and healthy volunteers.
Dr. Oquendo teaches at Columbia University. Dr. Oquendo is a member of the American Psychiatric Association, the American
College of Neuropsychopharmacology, the APA SAMHSA Fellowship and Selection Corresponding Committee, Group for the
Advancement of Psychiatry, Association of Women Psychiatrists and the American Board of Psychiatry and Neurology, on
which she also functions as an examiner. She is the president-elect of the American Society of Hispanic Psychiatry. She is an
associate editor of the American Journal of Psychiatry and serves on the Scientific Advisory Council of the American Foundation
for Suicide Prevention. She is a member of the NIMH scientific review committee, Interventions and Treatment of Mood and
Anxiety Disorders (ITMA) responsible for providing peer review of applications for federally funded grants. She has authored or
co-authored over 150 peer-reviewed articles, chapters and editorials. She is the recipient of several awards including Exemplary
Psychiatrist Award from the National Alliance for the Mentally Ill (1993); Award from the National Alliance for the Mentally Ill
for Commitment to Multicultural and Underserved Communities (2002); Travel Award from American Foundation for Suicide Prevention (2003); the Marian Butterfield Early Career Psychiatrist Award from the Association of Women Psychiatrists (2004); and
the Gerald Klerman Award from the Depression and Bipolar Support Alliance (2005).
Madhukar H. Trivedi, MD, Moderator
Dr. Trivedi is currently a Professor and Chief of the Division of Mood Disorders, Department of Psychiatry, University of Texas
Southwestern Medical Center at Dallas. He holds the Betty Jo Hay Distinguished Chair in Mental Health and the Lydia Bryant
Professorship in Psychiatric Research. Dr. Trivedi is an established efficacy and effectiveness researcher in the treatment of
depression.
Dr. Trivedi has been a principal investigator in multiple clinical trials funded through NIMH and the Texas Department of Mental
Health. He has been involved with evidence-based depression guideline development since 1990, when he joined the Depression
Guideline Panel of the AHCPR. Dr. Trivedi has been the Director of the Depression Algorithm for TMAP since its inception. Dr.
Trivedi has served as the chair of the Depression Work Group of the International Psychopharmacology Algorithm Project and
as the scientific content expert for the San Antonio Cochrane Center’s evidence-based, AHCPR-funded efforts to update the
Depression Guidelines. Dr. Trivedi spearheaded the rollout of best practices for the treatment of MDD in various MHMR centers
across the State of Texas. Dr. Trivedi is also studying the effectiveness of treatments of Depression in Primary Care.
Dr. Trivedi was also the co-principal investigator of the NIMH-funded project entitled, “Sequenced Treatment Alternatives to
Relieve Depression” (STAR*D). Dr. Trivedi is currently the co-principal investigator of the Depression Trials Network Combining
Medication to Enhance Depression Outcomes (COMED) trial, which focuses on the use of specific antidepressant combinations to
increase remission rates by treating a broader spectrum of depressed patients and by capitalizing on additive pharmacological
effects. Dr. Trivedi is also principal investigator of three current NIMH grants entitled, “CBASP Augmentation for Treatment of
Chronic Depression (REVAMP),” “Treatment with Exercise Augmentation for Depression (TREAD),” and “Computerized Decision
Support System for Depression (CDSS-D).”
Dr. Trivedi has mentored multiple psychopharmacology postdoctoral fellows and research track residents over the past many
years in the Mood and Anxiety Disorders.
Dr. Trivedi has received numerous awards including the Gerald L. Klerman award from the National Depressive and Manic-
Depressive Association Scientific Advisory Board-NDMDA and the Psychiatric Excellence Award from the Texas Society of
Psychiatric Physicians-TSPP.
Dr. Trivedi is or has been a member of several institutional review groups of the NIMH. Dr. Trivedi has published over 275 articles
and chapters related to the diagnosis and treatment of mood disorders.
Disclosure Declaration
It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all its CE
activities. Faculty must disclose to the participants any significant relationships with commercial companies whose products or
devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has
evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure,
use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant
information only. It is not assumed that these relationships will have a negative impact on the presentations.
Dr. Campbell has no financial relationships to disclose in regard to the products and/or services discussed in this activity.
Dr. Chung has disclosed that has received a grant for “College Breakthrough Series—Depression”, supported by Aetna Foundation
and New York Community Trust. He serves on the speakers bureau of Jazz Pharmaceuticals and Pfizer Inc.
Dr. Oquendo has no financial relationships to disclose in regard to the products and/or services discussed in this activity.
Dr. Trivedi has disclosed that he receives research support Bristol-Myers Squibb Company, Cephalon, Inc., Corcept Therapeutics,
Inc., Cyberonics, Inc., Eli Lilly and Company, Forest Pharmaceuticals, Inc., GlaxoSmithKline, Janssen L.P., Merck & Co., Inc., National
Alliance for Research in Schizophrenia and Depression, National Institute of Mental Health, Novartis Pharmaceuticals Corporation,
Pfizer Inc., Pharmacia & Upjohn, Inc., Predix Pharmaceuticals, Solvay Pharmaceuticals, Inc., Wyeth-Ayerst Laboratories. He serves
as a consultant to Abbott Laboratories, Akzo Nobel (Organon International), AstraZeneca Pharmaceuticals, Bayer Corp., Bristol-
Myers Squibb Company, Cephalon, Inc., Cyberonics, Inc., Eli Lilly and Company, Fabre-Kramer Pharmaceuticals, Inc., Forest
Pharmaceuticals, Inc., GlaxoSmithKline, Janssen L.P., Johnson & Johnson Pharmaceutical Research & Development, LLC, Meade-
Johnson International Inc., Neuronetics Inc., Parke-Davis Pharmaceuticals, Inc., Pfizer Inc., Pharmacia & Upjohn, Inc., Sepracor Inc.,
Solvay Pharmaceuticals, Inc., VantagePoint Venture Partners, Wyeth-Ayerst Laboratories. Dr. Trivedi is on the speakers bureaus Abdi
Brahim, Akzo Nobel (Organon International), Bristol-Myers Squibb Company, Cephalon, Inc., Cyberonics, Inc., Eli Lilly and Company,
Forest Pharmaceuticals, Inc., GlaxoSmithKline, Janssen L.P., Pharmacia & Upjohn, Inc., Solvay Pharmaceuticals, Inc., Wyeth-Ayerst
Laboratories.
Unlabeled Use Disclosure
Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The
faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational
uses (any uses not approved by the FDA) of products or devices.
The joint sponsors, the faculty, and the New York State Office of Mental Health do not endorse the use of any product outside of
the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed
during this activity without evaluation of their patient for contraindications or dangers of use.
Questions about this activity? Call us at 877.CME.PROS (877.263.7767).
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