A Consensus Statement for Safety Monitoring Guidelines of Treatments for Major Depressive Disorder

This paper aims to present an overview of screening and safety considerations for the treatment of clinical depressive disorders and make recommendations for safety monitoring

Seetal Dodd; Gin S. Malhi; John Tiller; Isaac Schweitzer; Ian Hickie; Jon Paul Khoo; Darryl L. Bassett; Bill Lyndon; Philip B. Mitchell; Gordon Parker; Paul B. Fitzgerald; Marc Udina; Ajeet Singh; Steven Moylan; Francesco Giorlando; Carolyn Doughty; Christopher G. Davey; Michael Theodoros; Michael Berk

2011

Scholarcy highlights

  • There are data indicating that, independent of treatment, people with depression have lower bone mineral density and a higher fracture risk, which is likely to be a compound result of lifestyle factors, disease state and iatrogenic treatment effects. These disease-related effects, combined with the effects on treatment, suggest that screening for bone mineral density should be considered in people on long-term selective serotonin reuptake inhibitors, and in high risk groups such as the elderly, women and those with other risk factors such as fracture history, history of falls, low vitamin D, hypogonadism, hyperparathyroidism, thyroid dysfunction, systemic inflammatory disorders, and corticosteroid use
  • Optimal safety monitoring is part of a system of care committed to a culture of patient safety
  • The treating clinician is primarily responsible for decisions regarding treatment choice, making these decisions on the basis of shared decision making, in the context of a collaborative alliance, and communicating the risks and benefits to the patient
  • Computerized electronic medical records or checklists with reminder prompts may help with safety monitoring; systems for lines of communication, co-ordination of monitoring practices and for the interpretation of results need to be developed
  • The re-balanced risk–benefit ratio needs to be evaluated on an individual basis
  • The recommendations should be adapted to the needs of individual patients, taking into account broad risk factors such as age, general health, comorbidity, polypharmacy, capacity for adherence to monitoring procedures, and clinical diagnosis

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