Antidepressant medications are a treatment option, and clinical algorithms are used to take into consideration a patient’s current medications as well as past response to antidepressants. The care manager conveys the consult team’s suggestions about starting or changing antidepressants to the Ob-Gyn provider. The patient’s Ob-Gyn provider makes the ultimate clinical decisions to initiate or modify medications.
The first line choice of an antidepressant is usually a selective serotonin reuptake inhibitor (SSRI). If the patient had previously not tolerated an SSRI, an alternative might be used. Or, if the patient has responded well in the past to a different class of antidepressant, she may be restarted on a medication from that class. Antidepressants are titrated to a therapeutic dose over 4-6 weeks.
If a patient does not attain a full response to treatment (at least a 50% reduction in PHQ-9 score) after 8 weeks, then alternative treatments are considered including a trial of a different antidepressant, combining medication and PST-PC, augmenting the antidepressant medication, or making a referral to specialty mental health care.
The target for improvement in depression is at least a 50% drop in the PHQ-9 score from baseline. The PHQ-9 is administered at every contact with the depression care manager and if by 4-8 weeks, the PHQ-9 score has not decreased by at least 50%, the treatment plan is revised.
- Patients on Medication Only: Alternatives include increasing the dosage of the medication, switching to a different medication, or augmenting with another medication. Adding PST-PC psychotherapy is another possibility.
- Patients receiving PST-PC Only: Psychotherapy can be augmented with antidepressant medication.
- Patients with Persistent Symptoms: Women whose depression symptoms do not improve despite modifications in treatment are referred for specialty mental health treatment.
Providing information about depression and local resources for further assistance is an empowering aspect of DAWN. Participants may receive The Depression Helpbook; an NIMH pamphlet, Women & Depression: Discovering Hope; or Depression During & After Pregnancy, if applicable. When appropriate, referrals may also be offered for longer-term psychotherapy or psychiatry for more complex needs.