Morning Report

Paradigm Shift in Depression: Can an Antidepressant Make Things Worse?

Arefa Cassoobhoy, MD, MPH


June 02, 2017

Hello. I'm Dr Arefa Cassoobhoy, a practicing internist, Medscape advisor, and senior medical director for WebMD. Welcome to Morning Report, our 1-minute news story for primary care.

Mixed Depression Guidelines a Paradigm Shift

One third or more of adults diagnosed with major depression also have symptoms of hypomania or mania. In a paradigm shift, new guidelines suggest that patients with mixed features may gain more benefit from an antipsychotic than from an antidepressant.

In patients suffering from depression with mixed features, antidepressants alone typically don't work. They can actually worsen symptoms and even induce mania or suicidal thoughts. A referral to a psychiatrist may be needed to assist with diagnosis and treatment.

Clinicians are encouraged to think about the possibility of mixed features in all patients with depression. Monitor for signs of psychomotor acceleration. And remember, you won't know unless you ask about symptoms of mania or a family history of bipolar disorder.

For Medscape and WebMD, I'm Dr Arefa Cassoobhoy.

Follow Dr Cassoobhoy on Twitter at @ArefaMD


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