Epigenetics of Stress and Stress Disorders - Chapter 6 Depression management and pharmacoepigenetics

Several therapeutic strategies including pharmacotherapy, psychotherapy, and other somatic treatments such as neurostimulation are available for management of depression. In the absence of significant evidence base, treatment selection is informed by certain clinical and nonclinical factors and tailored to individual patient needs. Depression treatment involves three phases with specific goals for each phase: acute, continuation, and maintenance phase. Systematic use of measurement tools, such as validated depression instruments, is recommended to monitor outcomes and inform clinical decision-making throughout the depression care continuum. Stepped care and chronic disease/collaborative care model approach to depression management has shown improved outcomes and better response and remission rates. Stepped care approach includes evidence-informed switching and augmentation strategies that utilize pharmacotherapeutic and psychotherapeutic modalities as monotherapy or combination treatments. Management of patients with treatment-resistant depression requires combination treatments including use of neurostimulation modalities in some cases. Pharmacoepigenetics, an emerging field that studies epigenetic mechanisms and their relation to treatment response, may inform treatment selection in the future. Individualizing treatment selection may help personalize depression care.