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  • Atypical Antipsychotics in Major Depressive Disorder: When Current Treatments Are Not Enough

    neuroscienceCME TV

    Premiere Date: Wednesday, December 3, 2008

    This activity offers CE credit for:

    1. Physicians (ACCME/AMA PRA Category 1)
    2. Nurses (CNE)
    3. Pharmacists (ACPE)
    4. Psychologists (APA)
    5. Social Workers (NASW)
    6. Certified Case Managers (CCMC)

    All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Credit™

    Credit Expiration Date: Thursday, December 3, 2009


    Charles B. Nemeroff, MD, PhD Charles B. Nemeroff, MD, PhD 
    Leonard M. Miller Professor and Chairman
    Director, Center on Aging
    Department of Psychiatry and Behavioral Sciences
    Leonard M. Miller School of Medicine
    University of Miami
    Miami, FL

    Linda L. Carpenter, MD Linda L. Carpenter, MD 
    Chief, Mood Disorders Program
    Butler Hospital
    Associate Professor
    Brown Department of Psychiatry and Human Behavior
    Providence, RI

    Zachary N. Stowe, MD Zachary N. Stowe, MD 
    Director, Women’s Mental Health Program
    Professor in Psychiatry and Behavioral Sciences
    Emory University School of Medicine
    Atlanta, GA

    Statement of Need

    Despite the high prevalence of MDD and the availability of effective treatments, only one-third of patients experience remission.(1) While many patients show improvement with initial therapy, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial demonstrated that it is not to the level of remission or recovery.(2) Augmentation is particularly helpful in managing patients who have had a partial response to their initial treatment. There has been an increased use of atypical antipsychotics as augmentation agents for patients that do not achieve full remission with traditional antidepressants. For those patients requiring augmentation, is the dose of the atypical antipsychotic different, what is the risk-benefit profile for the use of these agents?

    In this evidence-based neuroscienceCME TV activity, experts will explore augmentation strategies to aid clinicians in choosing an individualized treatment plan for patients with difficult to treat depression.

    1. Fava M, Davidson KG. Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am 1996;19:179-200.
    2. Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006;163:28-40.

    Activity Goal

    To incorporate the latest evidence-based augmentation treatment strategies to improve outcomes for patients with MDD.

    Learning Objectives

    At the end of this CE activity, participants should be able to:

    • Recognize the importance of remission and recovery as treatment goals for MDD.
    • Identify the need for improved treatments and involving the patient in treatment decisions for MDD.
    • Evaluate the role of atypical antipsychotics in the treatment of patients with MDD who do not achieve full remission or recovery.

    Target Audience

    Physicians, physician assistants, nurse practitioners, nurses, psychologists, social workers, certified case managers, pharmacists, and other healthcare professionals with an interest in mental health.

    Credit Information

    CME Credit (Physicians):
    CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CME Outfitters, LLC, designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

    CNE Credit (Nurses):
    CME Outfitters, LLC, is an approved provider of continuing nursing education by the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

    It has been assigned code 6WASUP-PRV-0645. 1.0 contact hours will be awarded upon successful completion.
    Note to Nurse Practitioners: The content of this CNE activity pertains to Pharmacology.

    CEP Credit (Psychologists):
    CME Outfitters is approved by the American Psychological Association to sponsor continuing education for psychologists. CME Outfitters maintains responsibility for this program and its content. (1.0 CE credits)

    NASW Credit (Social Workers):
    This program was approved by the National Association of Social Workers (provider #886407722) for 1 continuing education contact hour.

    CCMC Credit (Certified Case Managers):
    This program has been approved for 1 hour by the Commission for Case Manager Certification (CCMC).

    CPE Credit (Pharmacists):
    ACPE CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 1.0 contact hours (0.1 CEUs)
    Universal Program Number: 376-000-08-022-L01-P (live presentation) 376-000-08-022-H01-P (recorded programs)

    Post-tests, credit request forms, and activity evaluations can be completed online at www.neuroscienceCME.com (click on the Testing/Certification link under the Activities tab - requires free account activation), and participants can print their certificate or statement of credit immediately (70% pass rate required). Otherwise, participants should fully complete and return both the credit request form and activity evaluation located within the course guide for this activity. A certificate or statement of credit will be mailed within 4-6 weeks to all who successfully complete these requirements.

    Linda L. Carpenter, MD
    Dr. Carpenter is Associate Professor of Psychiatry in the Warren Alpert Medical School at Brown University Department of Psychiatry and Chief of the Affective Disorders Program at Butler Hospital in Providence, Rhode Island. Dr. Carpenter completed her undergraduate degree in psychology at the University of Michigan, and subsequently worked in the Mood Disorders Research Program at the Western Psychiatric Institute in Pittsburgh, concurrently completing post-baccalaureate premedical coursework at the University of Pittsburgh. She obtained her MD from the University of Pennsylvania and went on to complete an internship in internal medicine, a residency program in psychiatry, and a clinical neuroscience research fellowship at Yale University.

    Dr. Carpenter has been recognized for her work investigating the neurobiology of, and new treatments for, major depression and other mood and anxiety disorders. Dr. Carpenter has conducted studies of novel pharmacotherapies (drugs) and somatic (nondrug) treatments for depression. She has been principal investigator in numerous clinical trials for patients with Treatment Resistant Depression, conducted at Butler Hospital. She has recently opened up the Butler Neuromodulation Clinic, which offers treatment with Transcranial Magnetic Stimulation (TMS), Vagus Nerve Stimulation (VNS) and Deep Brain Stimultion (DBS, clinical trial).

    Dr. Carpenter's federally funded translational research program focuses on the development of a viable biomarker ("endophenotype") signaling mood/anxiety disorders risk that can be measured in a standard outpatient laboratory setting. She is investigating whether the neuroendocrine blood test can have practical value in forecasting an individual’s future onset of mental health disorders and symptoms. Such a tool could guide early interventions to prevent or otherwise change the course of chronic and disabling conditions.

    Zachary N. Stowe, MD
    Dr. Stowe initiated his interest in Neuroscience while an undergraduate majoring in Chemistry at the University of Texas at Dallas. Dr. Stowe completed his medical training at the University of Texas Medical Branch at Galveston and began residency training in Psychiatry at Duke University Medical Center. He completed his residency at Emory University, followed by a fellowship in Psychopharmacology under the guidance of Charles B. Nemeroff, MD, PhD.

    Dr. Stowe founded the Women’s Mental Health Program in 1991 and has since focused his clinical and laboratory research on gender differences in mental illness. He brought his experience in laboratory science to the field of women’s mental health and has focused on the pharmacokinetics, pharmacodynamics, and pharmacogenetics of psychotropic medications during pregnancy and lactation. He has authored over 75 publications, several book chapters, a myriad of abstracts, and authored the ACOG guidelines for psychotropic medication use in pregnancy (2007, 2008). His research has significantly contributed to defining fetal and neonatal exposure to medications.

    Dr. Stowe has remained dedicated to teaching. He has served as a consultant and/or mentor on four K23 awards, 2 doctoral students (medical genetics, psychology), and 4 postdoctoral fellows. The Women’s Program provides elective rotations in clinical care and research for residents, junior faculty, and community clinicians.

    His collaborative efforts include extramural research with colleagues at UCLA, Harvard/MGH, Columbia, University of North Carolina, SUNY, and the Medical University of South Carolina. Currently, he directs the Women’s Mental Health Program at Emory and is the center director for a Translational Center of Research in Behavioral Sciences (TRCBS) focusing on the impact of perinatal maternal stress from NIH.

    Charles B. Nemeroff, MD, PhD, Moderator
    Dr. Nemeroff was born in New York City in 1949 and educated in the New York City Public School System. After graduating from the City College of New York in 1970, he enrolled in graduate school at Northeastern University and received a Master’s degree in Biology in 1973. He received his MD and PhD (Neurobiology) from the University of North Carolina at Chapel Hill. His residency training in psychiatry was conducted at both the University of North Carolina and at Duke University, after which he joined the faculty of Duke University. At Duke he was Professor of Psychiatry and Pharmacology and Chief of the Division of Biological Psychiatry before relocating in 1991 to Emory University School of Medicine in Atlanta, Georgia, where he is the Reunette W. Harris Professor in the Department of Psychiatry and Behavioral Sciences. His research has concentrated on the biological basis of the major neuropsychiatric disorders, including affective disorders, schizophrenia, and anxiety disorders. His clinical research is focused on the use of genetic, neuroendocrine, neuroimaging and neurochemical methods to comprehensively understand the pathophysiology of depression. In recent years he has uncovered the neurobiological mechanisms that mediate the increased risk for depression in victims of child abuse. He has also contributed to other seminal findings such as the burgeoning area of research concerning the relationship of depression to cardiovascular disease, as well as to identifying predictors of specific antidepressant treatment responses.

    Dr. Nemeroff has received numerous honors during his career, including the A.E. Bennett Award from the Society of Biological Psychiatry (1979), the Judith Silver Memorial Young Scientist Award from the National Alliance for the Mentally Ill (1989), both the Kempf Award in Psychobiology (1989) and the Samuel Hibbs Award (1990) from the American Psychiatric Association (APAP, and the Gold Medal Award and the Research Prize (1996) from the Society of Biological Psychiatry. In 1993 he was awarded the Edward J. Sachar Award from Columbia University and the Edward A. Strecker Award from The Institute of Pennsylvania Hospital. In 1997, he was the recipient of the Gerald Klerman Award from the National Depressive and Manic-Depressive Disorders Association and the Selo Prize from the National Alliance for Research in Schizophrenia and Depression. In 1998 he was the recipient of the Research Award in Mood Disorders from the American College of Psychiatrists and in 1999 he received the Bowis Award from the same organization. He was awarded the Menninger Prize in 2000 from the American College of Physicians, the Research Award from the American Foundation for Suicide Prevention in 2001, and the Burlingame Prize from the Institute of Living in 2002. In 2006 he received the American Psychiatric Association Research Mentoring Award and Vestermark Award, and in 2008 The Judson Marmor Award for Research. Dr. Nemeroff served as the Editor-in-Chief of Neuropsychopharmacology (2001-2006). With Alan F. Schatzberg, MD, he is co-Editor of the Textbook of Psychopharmacology, soon to be in its Fourth Edition, published by the American Psychiatric Association Press. He has served on the Mental Health Advisory Council of the National Institutes of Mental Health and the Biomedical Research Council for NASA. He is past President of the American College of Neuropsychopharmacology and the American College of Psychiatrists. He is currently a member of the Board of Directors of the American Foundation for Suicide Prevention and President of its Scientific Council. He is chair of the APA Committee on Research Training. In 2002 he was elected as a member of the Institute of Medicine of the National Academy of Sciences. He is currently the recipient of several research grants from the NIH, including a Conte Center for the Neurobiology of Major Mental Disorders, and has published more than 840 research reports and reviews.

    Disclosure Declaration

    It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all its CE activities. Faculty must disclose to the participants any significant relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

    Dr. Carpenter has disclosed that she serves as a consultant to/is on the advisory boards of Abbott Laboratories, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Cyberonics, Inc., Medtronic, Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., Sepracor Inc., and Wyeth Pharmaceuticals. She receives grant/research support from Cyberonics, Inc., the Department of Defense, NARSAD, National Institute of Mental Health, Pfizer Inc., Sepracor Inc., and UCB Pharma. Dr. Carpenter receives honoraria for CME from the American Psychological Association, AstraZeneca Pharmaceuticals LP, Cyberonics, Inc., Wyeth Pharmaceuticals. She is on the speakers bureaus of AstraZeneca Pharmaceuticals LP, Cyberonics, Inc., and Pfizer Inc. and has other financial or material interest in Neuronetics Inc.

    Dr. Stowe has disclosed that he receives research support from GlaxoSmithKline, National Institutes of Health, Pfizer Inc., and Wyeth Pharmaceuticals. He is on the speakers bureaus of Eli Lilly and Company, Forest Laboratories, Inc., GlaxoSmithKline, Pfizer Inc., and Wyeth Pharmaceuticals. He serves as a consultant to Bristol-Myers Squibb Company and GlaxoSmithKline.

    Dr. Nemeroff has disclosed that he receives research grants from NIH. He is on the scientific advisory boards of American Foundation for Suicide Prevention, AstraZeneca Pharmaceuticals LP, Forest Laboratories, Inc., Janssen/Ortho-McNeil, Mt. Cook Pharma, Inc., NARSAD, PharmaNeuroboost, and Quintiles Transnational Corp. He is a stockholder of or has equity in CeNeRx BioPharma, Corcept Therapeutics, NovaDel Pharma Inc., PharmaNeuroboost, and Reevax. Dr. Nemeroff serves on the Board of Directors of American Foundation for Suicide Prevention, George West Mental Health Foundation, Mt. Cook Pharma, Inc., and NovaDel Pharma, Inc. He holds patents for a method and devices for transdermal delivery of lithium (US 6,375,990 B1), method to estimate serotonin and norepinephrine transporter occupancy after drug treatment using patient or animal serum (provisional filing April, 2001).

    Unlabeled Use Disclosure

    Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

    CME Outfitters, LLC, the faculty, and AstraZeneca Pharmaceuticals do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

    Questions about this activity? Call us at 877.CME.PROS (877.263.7767).

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