Penn Primary Care Podcast Managing Depression and Anxiety in Primary Care
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Nov 9, 2021 Dr Joseph Teel and Dr Eleanor Anderson discuss the Penn Integrated Care model for managing depression and anxiety in primary care. Topics include the screening process, evaluation of depression severity, addressing risk concerns, the relationship between anxiety and depression, Cognitive Behavioral Therapy, medication options, and the benefits of collaborative care.
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Antidepressants Work Best For Moderate To Severe Illness
- Large meta-analyses show most antidepressants outperform placebo, but benefits are smaller in mild depression.
- Eleanor Anderson advises psychotherapy, exercise, and sleep hygiene for mild cases; meds for moderate to severe illness.
Pick SSRIs Based On Side Effects And Context
- Choose SSRIs based on side effect profile and patient context; escitalopram and sertraline are common go-tos.
- Eleanor prefers escitalopram for fewer interactions; Joe favors sertraline for pregnancy data.
Titrate Sertraline Slowly And Reassess Regularly
- Start sertraline low then titrate to typical treatment doses over weeks, monitor every 4–6 weeks and increase for partial response.
- Joe Teal starts 25 mg for a week then 50 mg, aiming toward 100 mg if needed for depression.