Treating Co-Morbid Depression and Coronary Artery Disease

Coronary Artery Disease is the leading cause of death in the United States and is one of the main contributors to the global burden of disease. One in four patients with coronary artery disease also suffer from depression, which adds to the risk of recurrent myocardial infarction and death. Guidelines exist to urge primary care […]

Premenstrual Dysphoric Disorder

Approximately 75% of women experience premenstrual changes – increased irritability, tension, depressed mood, breast tenderness and bloating – commonly referred to as premenstrual syndrome (PMS). About 5-10% of women experience far more substantial premenstrual mood symptoms known as premenstrual dysphoric disorder (PMDD). PMDD symptoms includes moderate to severe depressed mood, irritability, mood lability, anxiety, anger, […]

Is it Menopause or Depression?

Females in their 40s and 50s often present to their primary care providers with new-onset depressive symptoms. It can be difficult to assess if the symptoms are part of menopause/perimenopause or if they represent a new onset depressive disorder. One complicating factor is that menopause can independently increase the risk of onset of a depressive […]

Screening For Depression

Depression is the most common mood disorder in the general population.  In 2014, an estimated 15.7 million adults aged 18 or older in the U.S. had at least one major depressive episode in the past year. This number represented 6.7% of all U.S. adults.  In 2014, an estimated 11.4% of adolescents aged 12 to 17 […]

Important Drug Interactions with the SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used psychotropic medications to treat depression and anxiety. It is important to be aware of common drug interactions between them and other medications, especially because some SSRIs are competitive inhibitors of a variety of cytochrome P450 liver enzymes. Therefore, they can significantly increase the blood levels […]

ADHD And Co-Morbid Tic Disorder

A call recently came into the SmartCare PC2 line that highlights an important clinical situation. Case Presentation: 10 yo boy with history of motor tic disorder (eye blinking, shoulder shrugging) who was then diagnosed with ADHD combined type. He was started on Concerta and titrated to 36 mg qAM, which has been helpful for his […]

Treatment of Alcohol Abuse

While behavioral treatments and support groups are the mainstay of treatment for alcohol abuse problems, there are medications that can be helpful as well. Naltrexone is an opiate antagonist that is used for the treatment of alcohol dependence. Research shows that it is particularly useful in decreasing heavy drinking. It is found to be more […]

Management of Alcohol Withdrawal in the Outpatient Setting

Approximately 2% to 9% of patients seen in a family physician’s office have alcohol dependence. These patients are at risk of developing alcohol withdrawal syndrome (AWS) if they abruptly abstain from alcohol use.  Treatment goals for patients with AWS are to reduce withdrawal symptoms; prevent seizures, delirium tremens, and death; and prepare the patient for […]

Treatment Approaches for GAD

The main treatment approaches for GAD comprise psychotherapy, pharmacotherapy or a combination of both. The often chronic and disabling nature of GAD means that some individuals may fail to respond fully to first-line treatment.  Your patients may require a sequential trial of treatments or possibly the use of combination therapy. Given the chronic nature of […]

Generalized Anxiety Disorder (GAD)

Anxiety disorders are the most prevalent of all psychiatric disorders, with generalized anxiety disorder (GAD) being the most common seen in primary care. Nearly 8% of patients consulting a primary care provider have GAD according to the World Health Organization (WHO). Despite this, it is a diagnosis that can easily be missed. The good news […]