Major depression in adults in primary care.

GUIDELINE TITLE
Major depression in adults in primary care.

BIBLIOGRAPHIC SOURCE(S)
Institute for Clinical Systems Improvement (ICSI). Major depression in adults in primary care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2009 May. 94 p. [295 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: Major depression in adults in primary care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); May 2008. 84 p.

** REGULATORY ALERT **
FDA WARNING/REGULATORY ALERT
Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.

December 3, 2009 - Valproate sodium (valproic acid and divalproex sodium): The U.S. Food and Drug Administration (FDA) notified health care professionals and patients about the increased risk of neural tube defects and other major birth defects, such as craniofacial defects and cardiovascular malformations, in babies exposed to valproate sodium and related products (valproic acid and divalproex sodium) during pregnancy. Healthcare practitioners should inform women of childbearing potential about these risks, and consider alternative therapies, especially if using valproate to treat migraines or other conditions not usually considered life-threatening.

December 2, 2009 - Norpramin (desipramine hydrochloride): Sanofi-Aventis and the U.S. Food and Drug Administration (FDA) notified healthcare professionals of changes to the Warnings and Overdosage sections of the Prescribing Information for Norpramin (desipramine hydrochloride), indicated for the treatment of depression. The new safety information states that extreme caution should be used when this drug is given to patients who have a family history of sudden death, cardiac dysrhythmias, and cardiac conduction disturbances; and that seizures precede cardiac dysrhythmias and death in some patients.

July 1, 2009 - Chantix or Champix (Varenicline) and Zyban or Wellbutrin (bupropion or amfebutamone): The U.S. Food and Drug Administration (FDA) notified healthcare professionals and patients that it has required the manufacturers of the smoking cessation aids varenicline (Chantix) and bupropion (Zyban and generics) to add new Boxed Warnings and develop patient Medication Guides highlighting the risk of serious neuropsychiatric symptoms in patients using these products. These symptoms include changes in behavior, hostility, agitation, depressed mood, suicidal thoughts and behavior, and attempted suicide.

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Major depression in adults in primary care.