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CME: Updates in the Treatment of Major Depressive Disorder (MDD) Pharmacotherapy and Barriers to Optimal Care


Activity Description / Statement of Need:

In this online, self-learning activity:


Major depressive disorder (MDD) is presently and has been a persistent major public health burden for several decades. Based on the National Comorbidity Survey data using the Composite International Diagnostic Interview, the estimated risk of MDD over any given 12-month period is 7.6%, with an estimated lifetime risk of 16.2%. Another estimate, from a recent wave of the National Health and Nutrition Examination Survey subdividing by gender indicates that 17.5% of men and 25.5% of women across all age groups overall report having experienced depressive symptoms in the past. Unfortunately, 58.8% of adults with symptoms classified as moderate and 36.9% of adults with symptoms classified as severe neither saw mental health professional nor received pharmacological treatment, suggesting a gap between present and optimal treatment of MDD.

Target Audience:

Healthcare professionals specializing in: family medicine, internal medicine, mental health, neurology and psychiatry, or those who otherwise commonly care for patients with MDD or related psychiatric diseases.

This program is supported by an educational grant from Alkermes.

Release Date: April 05, 2018 -- Expiration Date: April 05, 2020

Faculty: Darin Signorelli, MD


Primer and updates on MDD’s epidemiology, neuropathophysiology, presentation, comorbidities, and psychosocial impact

  • MDD’s (and other diseases’) implicated roles in disability; patient hesitancy about self-presentation and report due to public perceptions of mental illness or lack of familiarity with some depressive symptoms
  • Prevalence and lifetime risk
  • Differential diagnosis
  • Neurobiology and etiology of MDD
  • A quick review of the DSM-5 criteria and key differences from DSM-IV-TR
  • Diagnostic tests: cost and sensitivity/specificity

Updates in MDD treatment and strategies for barriers to care

  • Goals of care, treatment settings, and defining treatment outcomes
  • Comorbidity management (anxiety, mood and attention disorders, etc.)
  • Risk assessment of suicide
  • Involvement of family / significant others / caretakers in relevant cases
  • Primer on more recently approved agents
  • Oral and transdermal therapy
  • MOA review
  • Biomarker predictors of response to antidepressant therapy
  • Inadequate response
  • Cross-titration
  • Severe, refractory cases (includes review of adjunctive augmenting strategies)
  • Improper initial diagnosis
  • Inadequate medication duration or dose
  • Poor adherence (lack of patient understanding, adverse effect management, stigma)
  • Relationship with the clinician (role of effective establish of relationship, teaching)
  • Pharmacotherapy updates
  • Emerging strategies, trends, and new drug therapies in recent years, including novel formulations aimed at improving adherence
  • The role of nonpharmacotherapeutic strategies (including psychotherapy, neurotherapeutic treatments)
  • Other updates, clinical pearls, and exceptions in treatment
  • Contemporary challenges in the MDD treatment
  • Best practice: putting it all together
  • Patient case(s)


Learning Objectives

By the end of the session the participant will be able to:

  • Describe the pathophysiology of MDD and the role the neurotransmitters plays in it such that it informs pairing with present treatment mechanisms
  • Describe the benefits and risks of different pharmacotherapeutic treatments for MDD and take them into account when formulating a treatment plan for different patients
  • List present and emerging treatment options for MDD and apply them to patient cases using evidence-based medicine
  • Describe challenges to the successful management of MDD relating to treatment adherence and develop corresponding solutions
  • Identify barriers to care in patients with MDD and develop strategies to abate them


ACCME Activity #201226540


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.


Faculty Disclosure:  Darin Signorelli, M.D., Assistant Professor, Keck School of Medicine, USC, has no relevant conflicts of interest to disclose.


Faculty DOES plan to discuss off-label or investigational uses of a commercial product.


Disclosures of Educational Planners: Charles Turck, PharmD has no relevant conflicts of interest to disclose.


Commercial Support Disclosure: This program is supported by an educational grant from Alkermes




  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

Additional Courses That Are Related To This Activity

Best Practices and Advances in Treatment Strategies in Bipolar Disorder Pharmacotherapy

Alcohol Use Disorder (AUD): Therapeutic Updates and Best Practices

Major Depressive Disorder (MDD): Updates from the American Psychiatric Association Annual Meeting (APA) 2017

Schizophrenia: Updates from the American Psychiatric Association Annual Meeting (APA) 2017