Management | Health Spectrum Amy

When a patient is experiencing an inadequate response to their treatment plan, clinicians can draw on a range of MDD management strategies.
Given the many potential treatment pathways, consulting an evidence-based algorithm for managing an inadequate response is helpful.
Pharmacologic approaches to the treatment of residual symptoms following an adequate trial of an antidepressant include increasing the dose, switching to an agent of another class, or augmentation (ie, adding a medication to the current treatment regimen).
When determining whether to switch or add an adjunctive medication, it is helpful to consider several key factors, including patient preference, how many antidepressants have already been trialed, and how well the current medication is working and being tolerated.
In Jonathan’s case, the patient has expressed a preference for continuing with the agents he has been prescribed, as he has seen some benefit. Thus, the most appropriate next steps might include increasing the dose of his current medications or augmenting with a third medication.
The addition of non-pharmacologic interventions (eg, talk therapy, exercise, diet, meditation) is another important option for Jonathan, and one he was open to.

When a patient is experiencing an inadequate response to their treatment plan, clinicians can draw on a range of MDD management strategies.
Given the many potential treatment pathways, consulting an evidence-based algorithm for managing an inadequate response is helpful.
Pharmacologic approaches to the treatment of residual symptoms following an adequate trial of an antidepressant include increasing the dose, switching to an agent of another class, or augmentation (ie, adding a medication to the current treatment regimen).
When determining whether to switch or add an adjunctive medication, it is helpful to consider several key factors, including patient preference, how many antidepressants have already been trialed, and how well the current medication is working and being tolerated.
In Jonathan’s case, the patient has expressed a preference for continuing with the agents he has been prescribed, as he has seen some benefit. Thus, the most appropriate next steps might include increasing the dose of his current medications or augmenting with a third medication.
The addition of non-pharmacologic interventions (eg, talk therapy, exercise, diet, meditation) is another important option for Jonathan, and one he was open to.

Management plans for patients with HAE should include these general measures (3-5):
- Patient education
- Screening family members
- Trigger identification and avoidance
Because HAE is autosomal dominant, patients should be given information about the risk of inheritance and discuss screening of other family members (4).
Several long-term prophylactic therapies for HAE have been shown to improve patient QoL (5).
Long-term prophylaxis has been working well for Amy.
Patient needs, goals, and preferences regarding treatment evolve over time.
Individual needs, goals, and preferences mean that one size does not fill all when it comes to on-demand and prophylactic therapy strategies (4,5).
Decisions about long-term prophylaxis should be individualized (3-5).
Discussions with Amy to review her long-term prophylaxis should occur at every visit, at least once a year (5).
Specific questions can elicit information about the burden of living with HAE, which can be helpful to assess the need for treatment or prophylaxis (3).