W. Clay Jackson, MD, DipTh, on Evaluating and Managing Major Depressive Disorder

In this video, W. Clay Jackson, MD, DipTh, gives a recap of his presentation on major depressive disorder at the 2020 Practical Updates in Primary Care virtual series. 

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W. Clay Jackson, MD, DipTh, is an assistant professor of clinical psychiatry and family medicine at the University of Tennessee.



W. Clay Jackson: Hi. So my name is Clay Jackson. I am an assistant clinical professor of psychiatry and family medicine in the Department of Psychiatry and Family Medicine at the University of Tennessee College of Medicine in Memphis, Tennessee. So greetings from Memphis.

So happy for those of you that have been able to participate in the Practical Updates for Primary Care conference. What a wonderful time to be together, to learn from each other, to engage as a practicing community of leading researchers and scientists, yes, but also leading clinicians who are in the trenches seeing patients Monday through Friday, working hard to make a difference in primary care patients' lives. I so enjoy the content of this conference, you know, obesity, chronic pain, low back pain, IBS, Major Depressive Disorder. These are things that we all see quite often and I know that you are being inspired in the same way that I am by the content in terms of the difference that we can make for patients.

In terms of my session on the evaluation and management of Major Depressive Disorder, a couple of key takeaways that we want to remember. Number one, we want to make the management of depression a quantitative enterprise and not a qualitative enterprise. We want to use metrics to help us understand the patient's symptomatology and to guide us along key decision points along the patient's journey. That's number one.

Number two, what do we do when our therapy is not working? We know there's a difference between remission and response. We talked about how remission is key for the patient's function and for their biologic well being. It's also key for preventing relapse. And so we want to drive through remission. What do we do if we're not there yet?

Well, we can switch therapies, if the patient's not getting better at all, or having a side effect. We can augment with an atypical antidepressant agent. We can also do non-pharmacologic therapy. So we can refer the patient for mindfulness based cognitive therapy or cognitive based behavioral therapy. We can refer them for nutritional interventions. We know the Mediterranean diet tends to promote wellness in patients who have mental illness. And we can also refer those patients for an exercise program. We talked about the dose base exercise, or aerobic exercise that patients can use to drive positive mental health challenge up. And we talked about the dosages of exercise that we can actually use in writing prescriptions for that patient in ways that can drive positive changes in their mental well being.

So I hope with these key takeaways that you'll have something that you can help your patients with this week. Let's use a PHQ-9 or other tool to guide metrics. Those are already embedded in most of your EHRs, you use them in your practice, but we don't just want to look at that as a number. We want to follow that for 50% response. We want a 20% response in two weeks and then we want to get that score, all the way down to five and 10 to make sure that patient is approaching remission. If that's not happening, we're going to switch therapies, if nothing good is happening with a drug, or we're going to augment is something goods happening but we're not quite there.

We're to look at non-pharmacological interventions that we can use such as CBT or MBCT to drive positive changes. We're going to speak about nutritional changes and exercise changes to get control over the patient's obesity, that are overweight, because that as we know can mitigate against response. And then finally we're going to look to adherence. We're going to make sure that the patient is adhering to the therapy that we prescribed, whether that's non pharmacologic or pharmacologic in order so that those patients can continue to move toward wellness. After we get them sort of, into remission, we want to make sure that we drive wellness as high as possible so to have a psychological resilience to avoid future episodes and also to increase your quality of life today.

I hope these are practical tips to help you and your patients and I wish you every success in treating this challenging illness that is so rewarding when you see patients get better because it affects the totality of their lives, their families and their communities. Thanks for participating in PUPC 2020.