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    This model was built to foster future research, provide a logical framework for teaching residents how to select antidepressants, and equip primary care doctors with a structured treatment strategy to deliver optimal patient-centered care in the management of a debilitating disease: major depressive disorder.

    major depressive disorder is a silent epidemic that warrants a vigorous primary care response.

    The evidence suggests that it works at least in moderate depression but maybe less effective in severe depression.

    It provides an option when the patient is unable to tolerate anything else.

    The choice of medication should be guided by anticipated safety and tolerability, which aid in compliance; physician familiarity, which aids in patient education and anticipation of adverse effects; and history of previous treatments.

    Often, treatment failures are caused not by clinical resistance but by medication noncompliance, inadequate duration of therapy, or inadequate dosing.

    Even at a relatively high dose of fluoxetine, she continued to experience significant anxiety.

    She was taking fluoxetine, brand name Prozac, for a number of months.In this article we present the theory and evidence for an individualized, patient-centered treatment model for major depression designed around a targeted symptom cluster-based approach to antidepressant selection.When using this model for healthy adults with major depressive disorder, the choice of antidepressants should be guided by the presence of 1 of 4 common symptom clusters: anxiety, fatigue, insomnia, and pain.Other factors to consider include: Some people experience withdrawal effects after missing 1 or 2 doses, especially when using a drug with a short half-life (e.g. At the end of a treatment course, taper antidepressant over several weeks and monitor for withdrawal symptoms. SSRIs are relatively activating and usually best given as a single daily dose each morning.Routine use of doses above those recommended rarely increases antidepressant effect.

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