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Key Takeaways for the Management of MDD


Carmen Kosicek, MSN, PMHNP-BC; Charles Montano, MD; and Gus Alva, MD, DFAPA, provide take-home messages for the management of patients with MDD and other depressive disorders.

Gus Alva, MD, DFAPA: I want to thank everybody for this rich and informative discussion. Carmen, Charles, you guys are amazing. Before we conclude, I’d like you each to share a final thought with our colleagues out there. Ladies first. Carmen, any closing thoughts that you think might be important?

Carmen Kosicek, MSN, PMHNP-BC: We all recognize not necessarily the statistics but how big of an arena this is and that it impacts our patients. It could impact the provider or their family or someone close to home. I beg all our peers across the country to light that fire within you: know your meds andevidence-based practices. In school we couldn’t turn in a paper if the reference was more than 5 years old, yet many providers are prescribing from decades ago. Why? We need to learn the meds, how they hit different neurotransmitters, and what they can truly do. What’s at your fingertips? It’s there. Let’s learn about them and use them. It would be a seamless implementation for even the newer agents coming down the pike.

Gus Alva, MD, DFAPA: Looking beyond the monoaminergic [system], Charles, what are your closing thoughts?

Charles Montano, MD: Carmen said it beautifully. There’s no question that as a primary care doctor or a provider, whether you’re a nurse practitioner or a PA [physician assistant], 1 of the most important illnesses you’ll ever treat is major depression. You’re not only giving someone the opportunity to climb out of the pit and have a decent quality of life but also helping the entire family and the economy. The presenteeism of absenteeism associated [with major depressive disorder] is horrific. That causes more pain. If you’re feeling vibrant and alive and you want to be healthy, you’re going to follow your doctor’s, PA’s, or nurse practitioner’s advice. You’re going to take the medications that they prescribe for many other medical problems….

There’s a disharmony between managed care and what we’d like for our patients. Unfortunately, price is often the driving force for use of an antidepressant, which is unfortunate for all the reasons Carmen stated. We always we look at how long people are with a company—maybe 2 or 3 years, and then they move on to another. They don’t want to invest long term the way they should to heal from this disease. This is a chronic illness, and it needs to be invested in for the long term—not just the 1 or 2 years you’re with a company—to prevent hospitalization, suicide, and worsening of depression over time. We’ve got an uphill battle. It’s good that we’re doing educational work like this. We have to make this available to every practitioner out there. They need to get involved and realize that if they don’t treat depression, who will?

Gus Alva, MD, DFAPA: Thank you both for spending time with us. We want to thank you all for watching this Psychiatric Times® presentation. If you enjoyed the program, please subscribe to our e-newsletters to receive upcoming programs and other great content right in your in-box.


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