HCCIntelligence™ Webinar Recording: Managing Depressive Disorders in Homebound Patients

Webinar Q and A

Pdf Summary

The document from HCCIntelligence discusses various aspects of managing depressive disorders in homebound patients, focusing on adjunct therapies, quality measures, innovative strategies, and specific conditions like depression with delusional features, particularly in elderly patients.<br /><br />1. **Adjunct Therapy Post-SSRIs**: The debate between switching versus augmenting after an initial SSRI regimen remains unresolved. Switching can be simpler and less risky in terms of drug interactions, while augmenting can be quicker and preserve partial response. The choice of adjunct should align with symptoms: bupropion for apathy and fatigue, mirtazapine for anxiety and insomnia, and aripiprazole or brexpiprazole for severe depression or delusions.<br /><br />2. **Quality Measures and National Benchmarks**: Depression management can be assessed using outcome measures like GDS or PHQ, as well as process measures like the number of patients screened and treated.<br /><br />3. **Access to Therapies for Homebound Patients**: Given the shortage of mental health providers available for home visits, using apps like CBT-I and telecounseling can be effective. Practices should compile local and virtual mental health resources. Zencare provides an online database of mental health providers, including those offering remote sessions in select cities.<br /><br />4. **Managing Depression with Delusional Features in Older Adults**: These conditions require immediate attention to the risk of violence and basic self-care abilities, often justifying hospitalization. Treatment typically involves combining an antidepressant with an antipsychotic, with a significant response expected within 2-3 weeks; otherwise, ECT may be considered.<br /><br />5. **Combining Antidepressants**: Optimizing a single antidepressant before switching or augmenting is generally recommended to avoid adverse interactions. Avoid using two serotonergic drugs together.<br /><br />6. **Medication for Elderly and Talk Therapy**: Sertraline or escitalopram are first-line for most elderly patients. For specific symptoms, bupropion or mirtazapine may be considered. Home talk therapy might involve digital contact or home visits from available therapists.<br /><br />7. **Switching Between SSRIs**: The process—whether abrupt or gradual—depends on the half-life of the medication. Cross-tapering may be used to mitigate discontinuation symptoms.<br /><br />8. **Cannabis**: Insufficient evidence exists to support its use for treating depression.<br /><br />This summary encapsulates the key points and recommendations for effectively managing depressive disorders in homebound patients as presented in the document.

Keywords

depressive disorders

homebound patients

adjunct therapies

quality measures

depression with delusional features

elderly patients

telecounseling

antidepressants

mental health resources

sertraline