Major depressive disorder (MDD) is a common mental illness and is one of the leading causes of disability and disease in the world. It is associated with serious emotional and biological manifestations that impact a person’s mood, feelings, thoughts, physical health, and behavior. Without getting the appropriate treatment, MDD symptoms can increase over time. The management of MDD is possible through both pharmacological therapy and psychotherapy. The increased availability of depressants means that patients can get the right treatment for the illness. The treatment can include Brintellix (vortioxetine) (FDA-approved drug), Modafinil (off-label drug), and cognitive behavioral therapy (nonpharmacological intervention).
Description of Medications
The FDA-approved drug for major depressive disorder is Brintellix (vortioxetine). Vortioxetine was approved by the FDA in September 2013. It functions as an immediate-release tablet and antidepressant. According to Pae et al. (2015), vortioxetine was found to be an effective treatment option for MDD. The drug was significantly more effective than the placebo, and those that were treated with the drug showed a significant improvement in their symptoms. The recommendation for using the drug is that it should be translated and integrated into clinical practice with caution.
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The off-label drug identified for the treatment of MDD is Modafinil. The drug has been primarily used to treat excessive sleepiness caused by narcolepsy or shift work sleep disorder. The drug has also been used along with other agents used to treat children with attention-deficit/hyperactivity disorder (ADHD). The drug was an experiment to be used to treat MDD and was found to be effective. According to Vaccarino et al. (2019), Modafinil showed a reduction in MDD symptoms and showed improvement in executive functioning four weeks after the initial prescription. The studies were also different from placebo-controlled and open-label trials among MDD populations.
Cognitive-behavioral therapy (CBT) was identified as one of the most effective approaches to the treatment of MDD. Gartlehner et al. (2017) observed that CBT had reliable evidence of being an effective treatment for the illness. Moderate evidence showed that using CBT along with other antidepressants could improve one’s symptoms. CBT involves a therapy session and could be a more effective option than medication. One of the approaches used in CBT involved the therapist using Socratic questions to challenge faulty thinking among the patients. The therapist could use the approach to identify cognitive errors and problematic thoughts. The behavioral strategy that could be applied involves increasing pleasant activities through the use of behavioral activation.
Risk Assessment
The analysis of the three treatment approaches showed that there are possible risks with using each drug. The risk of using vortioxetine is that it could lead to a relapse of one’s symptoms after withdrawing from using the drug. The withdrawal symptoms include nausea, dizziness, vomiting, irritability, headaches, and nightmares. The benefits of the drug are that it functions as a selective serotonin reuptake inhibitor (SSRI) that could improve one’s mood, sleep, appetite, and energy levels. The possible benefits outweigh the drawbacks, and the drug should be used to treat MDD. The possible risks of using Modafinil are that it can have side effects of headaches, nausea, nervousness, insomnia, and diarrhea. The benefit of using the drug is that it can enhance one’s mood and has memory-enhancing effects. The side effects of the drug are not severe, meaning that it could be applied as an effective treatment approach for MDD.
Clinical Guidelines
There are specific clinical guidelines and procedures to be followed when treating MDD. The condition can present itself with other symptoms of depressed mood that could indicate other conditions. The assessment should thus involve a proper establishment of the diagnosis. The assessment should be undertaken through a detailed history, physical examination, and mental health examination. Differential diagnoses should also be considered, like organic depression and bipolar disorder. The assessment should analyze the severity of the illness, personality factors, risk of harm to others, and personality factors. A discussion of the treatment settings should be undertaken after a clear diagnosis. The treatment can involve both pharmacological and nonpharmacological management and should be customized based on the needs of the patient.
References
Gartlehner, G., Wagner, G., Matyas, N., Titscher, V., Greimel, J., Lux, L., ... & Lohr, K. N. (2017). Pharmacological and nonpharmacological treatments for major depressive disorder: review of systematic reviews. BMJ open , 7 (6), e014912. https://bmjopen.bmj.com/content/7/6/e014912.abstract
Pae, C. U., Wang, S. M., Han, C., Lee, S. J., Patkar, A. A., Masand, P. S., & Serretti, A. (2015). Vortioxetine: a meta-analysis of 12 short-term, randomized, placebo-controlled clinical trials for the treatment of major depressive disorder. Journal of psychiatry & neuroscience: JPN , 40 (3), 174. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409435/
Vaccarino, S. R., McInerney, S. J., Kennedy, S. H., & Bhat, V. (2019). The potential procognitive effects of Modafinil in major depressive disorder: a systematic review. The Journal of clinical psychiatry , 80 (6), 0-0. https://pubmed.ncbi.nlm.nih.gov/31599501/
