ACTIVITY DESCRIPTION

Family physicians (FPs) are on the frontline for depression care, often being the first line of defense for diagnosis and management. This 0.5-hour, CME-certified activity will guide clinicians through a brief patient case, challenging the learner to address questions on the following:

• Clinical factors in the primary-care setting that influence treatment outcomes in major depressive disorder (MDD)
• Identification and management of residual symptoms
• Tools for effective monitoring of treatment outcomes
• Nonpharmacologic and pharmacologic therapies to treat patients to goal: remission and recovery
• Strategies to promote adherence to treatment regimens

LEARNING OBJECTIVES

Upon completion of this educational activity, participants should be able to:

• Recognize the signs and symptoms of MDD in patients with comorbidities
• Assess the benefits versus risks of augmentation therapy in patients with MDD who have not achieved full symptomatic remission and recovery
• Identify strategies to increase treatment adherence in patients with MDD
• Utilize nonpharmacologic therapies to augment treatment regimens for patients with MDD

FACULTY

Bradley N. Gaynes, MD, MPH
Professor and Associate Chair of Research Training and Education
Department of Psychiatry
University of North Carolina School of Medicine
Chapel Hill, NC

W. Clay Jackson, MD, DipTh
Clinical Assistant Professor of Family Medicine and Psychiatry
University of Tennessee College of Medicine
Memphis, TN

FACULTY BIOGRAPHIES

Bradley N. Gaynes, MD, MPH, is Professor and Associate Chair of Research Training and Education in the Department of Psychiatry at the University of North Carolina (UNC) at Chapel Hill. Dr Gaynes earned his medical degree from the University of Virginia School of Medicine, and completed his residency in psychiatry at the University of Colorado Health Sciences Center. His postgraduate training has included a Robert Wood Johnson Clinical Scholar Fellowship at UNC, where he also received his Master of Public Health degree in epidemiology and completed a fellowship in preventive medicine. Dr Gaynes works at the crossroads between clinical trials research and mental health services research (including comparative effectiveness reviews), and he focuses his clinical and research efforts on treatment-resistant depression and improving the delivery of depression care in nonpsychiatric settings, including primary care, obstetrical, and HIV practices.

As a clinical trials researcher, Dr Gaynes has participated in seminal work on primary care depression management. He has been funded through a National Institute of Mental Health (NIMH) Career Development Award (K23) entitled, “Targeting Treatment-Resistant Depression in Primary Care” and served as the Director of the UNC Regional Center for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Currently, Dr Gaynes is Principal Investigator (PI) on an NIMH-funded R34 Planning Grant adapting measure-based care to manage depressed patients with HIV in Cameroon. He is co-PI on an NIMH-funded R01 Research Project Grant Program assessing whether HIV outcomes in depressed patients with HIV are better after randomization to measure-based care compared to usual care.

As a mental health services researcher, Dr Gaynes has previously served as PI for the US Preventive Services Task Force’s evidence report on screening for suicide risk in primary care; as Co-investigator on a Task Force report on screening for depression in primary care; and as PI on a recently completed AHRQ-funded comparative effectiveness review of nonpharmacologic interventions in the management of treatment-refractory depression. He is currently an investigator on the UNC/RTI collaborative project, “Comprehensive EPC Comparative Effectiveness Reviews for Effective Health Care.”

W. Clay Jackson, MD, DipTh, is a Clinical Assistant Professor of Family Medicine and Psychiatry at the University of Tennessee College of Medicine in Memphis, where he maintains a private practice in family and palliative medicine. He is Medical Director of Comprehensive Primary Care and Medical Director for Methodist Hospice and Palliative Services, also in Memphis. In addition, Dr Jackson is the Fellowship Director for Palliative Medicine at the University of Tennessee College of Medicine. From this professional platform, he has led a team of dedicated clinicians who have helped to transform the experience of seriously ill patients in the Mid-South.

Dr Jackson earned his medical degree at the University of Tennessee Health Science Center in Memphis and completed his residency at the University of Tennessee/Baptist Tipton Family Medicine. He earned his Diploma in Theology at Oxford University in England. He is a Fellow of the American Academy of Family Physicians, holds a Certificate of Added Qualification in Hospice and Palliative Medicine, and is a member of the Alpha Omega Alpha Medical Honor Society.

Dr Jackson has been the recipient of many clinical and teaching awards and has had his research published in numerous journals, including Family Medicine, Journal of Affective Disorders, and JAMA. A frequently invited speaker at national and international professional meetings, he has also been featured in several multimedia projects concerning the treatment of affective disorders and chronic pain.

DISCLOSURE STATEMENTS

In accordance with the Accreditation Council for Continuing Medical Education, the NCAFP requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest.

Activity Planning Faculty
The activity content was developed by Bradley N. Gaynes, MD, MPH, and W. Clay Jackson, MD, DipTh.

Activity Faculty
Bradley N. Gaynes, MD, MPH
Nothing to disclose with regard to commercial support

W. Clay Jackson, MD, DipTh
Advisory Board: Forest Pharmaceuticals, Inc; Merck & Co; Otsuka America Pharmaceutical, Inc; Sunovion Pharmaceuticals Inc; Takeda Pharmaceutical Company Ltd
Chief Medical Officer: Halio Health
Speakers Bureau: Sunovion Pharmaceuticals Inc

In order to resolve conflict of interest, presentations of this activity were peer reviewed by an independent reviewer. The reviewer has no relationship with a commercial interest. The resulting certified activity was found to provide educational content that is current, evidence-based, and commercially balanced.

Independent Reviewer
Alisa C. Nance, MD
Nothing to disclose with regard to commercial support

Educational Planning Committee
NCAFP
Marietta Ellis
Nothing to disclose with regard to commercial support

Spire Learning
Erin Franceschini, MS, and Kashemi D. Rorie, PhD
Nothing to disclose with regard to commercial support

Karin McAdams
Nothing to disclose with regard to commercial support

Jeanne Prater
Shareholder (Spouse/Partner): Johnson & Johnson
Employee (Spouse/Partner): Novo Nordisk

DISCLAIMER

The content and views presented in this educational activity are those of the presenter and do not necessarily reflect those of the NCAFP, Spire Learning, Takeda Pharmaceuticals International, Inc., U.S. Region and Lundbeck. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity.

OFF-LABEL STATEMENT

The faculty presenter intends to discuss the non–FDA-approved use of lithium and thyroid hormone as augmentation agents for MDD. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.

LEVELS OF EVIDENCE

Levels of evidence are provided for any patient care recommendations made during this activity. The following levels of clinical confidence are provided by the American Psychiatric Association Practice Guideline for the Treatment of Patients With Major Depressive Disorder (3rd edition):

[I] Recommended with substantial clinical confidence

[II] Recommended with moderate clinical confidence

[III] May be recommended on the basis of individual circumstances