Presented as a Satellite Symposium During the 2009 ACCP Annual Meeting
Monday, October 19, 2009
Hilton Anaheim
Anaheim, California

This activity is supported by an unrestricted educational grant from Bristol-Myers Squibb Company
and Otsuka America Pharmaceutical, Inc.

This symposium is your compass for navigating your career in the right direction.

Program Purpose Selected References Program Overview Educational Grantor Target Audience Continuing Education Credit Learning Objectives Program Eligibility Program Agenda Print Off Program Slides Faculty Biographies View the Program Faculty Disclosure Information Post Test and Continuing Education Credit Link Abstracts   Program Purpose: Despite the multitude of antidepressant options available, most depressed patients fail to achieve remission even with adequate antidepressant monotherapy. Treatment-resistant depression continues to be a major and increasing healthcare burden. What is the role of the clinical pharmacist in guiding depression treatment? Treatment strategies should be evidence-based and tailored to the individual patient through the systematic measurement of symptom resolution, adverse effects, and patient functioning. Clinical pharmacists are influential in promoting safe and effective pharmaceutical care. Using their extensive knowledge of pharmacotherapeutic options along with the most recent evidence-based clinical treatment guidelines, pharmacists are able to identify, recommend, and monitor various pharmacotherapeutic strategies to optimize patient outcomes in treatment-resistant depression.  Back to top Program Overview: Treatment resistant depression is a major and increasing health burden to individuals and to society. Depression treatment should be guided by evidence-based research and tailored for the individual patient through the routine measurement of symptoms, adverse effects, and functioning, so as to optimize the sequential treatment approaches. Pharmacists practicing pharmaceutical care are perfectly suited to assist physicians in identifying optimal pharmacotherapy and improving medication-related outcomes. Clinical pharmacists are influential in promoting safe and effective pharmaceutical care for patients with depression. Educating clinical pharmacists that are influential in the practice of the pharmacy profession, as well as influential in recommending pharmacotherapy options to clinicians and policymakers in various health systems, will result in better treatment and ultimately improved patient outcomes.  Back to top Target Audience: This CE activity is intended for pharmacists and other healthcare professionals who have an interest in identifying and managing psychiatric patients with treatment resistant depression (TRD).  Back to top Learning Objectives: At the conclusion of this activity, participants should be able to: Describe current approaches to optimize remission from depression; Discuss the evidence and rationale for switching versus augmentation/combined therapy approaches; Implement a pharmaceutical care plan in the monitoring and management of potential medication-related adverse toxicities; and Discuss the role of pharmacist in the multidisciplinary collaborative approach to improving care of patients with depression.  Back to top Program Agenda: Introductory Remarks: Treating to Remission Patrick R. Finley, PharmD, BCPP (Chair) Professor of Clinical Pharmacy University of California, San Francisco San Francisco, CA Adjunctive Treatment of Residual Symptoms in Resistant Depression H. Brent Solvason, PhD, MD Assistant Professor Stanford University Palo Alto, CA Charles DeBattista, DMH, MD Stanford University collaborated on presentation content development Monitoring of Efficacy and Potential Adverse Effects in Augmentation Approaches Shannon J. Drayton, PharmD, BCPP Assistant Professor South Carolina College of Pharmacy Clinical Specialist Medical University of South Carolina Institute of Psychiatry Charleston, SC Expanding Role of Pharmacists in Care of Patients with Depression Patrick R. Finley, PharmD, BCPP Professor of Clinical Pharmacy University of California, San Francisco San Francisco, CA Panel Discussion and Q&A All Faculty Concluding Remarks Patrick R. Finley, PharmD, BCPP Professor of Clinical Pharmacy University of California, San Francisco San Francisco, CA  Back to top Faculty Biographies: Chair Patrick R. Finley, PharmD, BCPP is a professor in the University of California – San Francisco (UCSF), Department of Clinical Pharmacy, supporting the Department of Psychopharmacology and Behavioral Health. Dr. Finley was educated at the University of California –Santa Barbara (UCSB), and then pursued a doctorate in pharmacy at UCSF. He is a board certified psychiatric pharmacist (BCPP). Dr. Finley’s teaching, clinical, and research interests focus on the safe and efficacious use of psychotropic medications in a wide range of healthcare settings. His research interests in psychopharmacology span clinical, epidemiological, pharmacokinetic and health policy domains. Dr. Finley has spent much of the past decade developing collaborative care treatment models for depression that emphasize the role of clinical pharmacists as providers. In addition, he has been involved with several epidemiological studies analyzing the safety of antidepressants in children and adolescents, and recently embarked on a prospective investigation of risk factors associated with the development of postpartum depression. He currently serves on the Parental Depression Committee of the National Academies and the Institute of Medicine. Dr. Finley’s recent contributions to the medical literature include publications in Biological Psychiatry, Journal of Clinical Psychopharmacology, Journal of Nervous and Mental Disease, Archives of Internal Medicine, Psychosomatics, Psychopharmacology Bulletin, Drug Safety, Formulary, Clinical Therapeutics, Journal of Managed Care Pharmacy, Clinical Pharmacokinetics, Pharmacotherapy, Annals of Pharmacotherapy, and the American Journal of Health-System Pharmacy. He has written chapters in 10 medical textbooks, and currently serves as a referee and/or editorial board member for approximately 25 medical journals. Distinguished Faculty Shannon J. Drayton, PharmD, BCPP was educated at the University of South Carolina at Sumter, and pursued a doctorate in pharmacy from the University of South Carolina College of Pharmacy. She them completed a pharmacy practice residency and a psychiatry specialty residency at the Johns Hopkins Hospital in Baltimore. Dr. Drayton currently serves as an assistant professor at the South Carolina College of Pharmacy, Medical University of South Carolina (MUSC) campus in Charleston. She currently has an 8 month clinical practice at the MUSC Institute of Psychiatry in which she participates in medical rounds, teaching, and a range of patient care activities. Board certified in psychiatric pharmacy practice, Dr. Drayton’s primary areas of interest and research are in schizophrenia and mood disorders. Over the past 3 years, she has actively been involved in developing materials for the South Carolina Offering Prescribing Excellence (SCORxE) academic detailing program. A member of the College of Psychiatric and Neurologic Pharmacy, Dr. Drayton is a highly respected invited speaker to national society and academic programs. H. Brent Solvason, PhD, MD received his doctorate in cellular and molecular biology from the University of Alabama at Birmingham and his medical degree from the University of Alabama School of Medicine. He did his medical residency with the Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences. Dr. Solvason is a Diplomate of the American Board of Psychiatry and Neurology. He is an Assistant Professor in the Psychiatry Department at Stanford University, and is Assistant Director of the Psychopharmacology Clinic, and the Depression Research Clinic there. He is also the Medical Director for the Electroconvulsive Therapy (ECT) Service. Dr. Solvason is presently the principle investigator on a number of projects studying Major Depression and treatment with novel brain stimulation technologies such as Vagal Nerve Stimulation, Transcranial Magnetic Stimulation, and Deep Brain Stimulation. He is also examining medication strategies for reducing cognitive impairment associated with the use of ECT. He has focused research on treatment resistant depression, and currently is examining a glucocorticoid antagonist as a strategy to normalize the stress hormone axis in individuals with depression unresponsive to extensive pharmacologic and psychological treatments. He is also the principle investigator for several studies sponsored by various pharmaceutical companies looking at the use of antidepressants in the treatment of major depression. The contributing faculty developed the content independently. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the educational sponsor or grantor. Back to top Faculty Disclosure Information: It is the policy of the University of Nebraska Medical Center, Center for Continuing Education and Letters & Sciences to ensure balance, independence, objectivity, and scientific rigor in all their educational activities. All faculty and planning committee members participating in this activity are expected to disclose to the audience any significant financial interest or other relationship he/she has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. It is not assumed that these financial interests or affiliations will have an adverse impact on the faculty presentations. They simply are noted here to fully inform course participants. Shannon J. Drayton, PharmD, BCPP Has no relationship to disclose. Patrick R. Finley, PharmD, BCPP Advisory Board: Eli Lilly and Neuroscience Education Institute H. Brent Solvason, PhD, MD Research Support: AstraZeneca, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Neuronetics Consultant: Cephalon, Cyberonics, Forest, EliLilly, NeuroPace, Sepracor Unlabeled Uses/Investigational Uses/Not Yet Approved Commercial Products The symposium participants are advised that some sections in this educational activity may contain references to unlabeled or unapproved uses of drugs. Not all agents and/or protocols described in the presentations may be approved by the FDA. Pharmacists and other healthcare providers should note that the use of these agents outside their current approved labeling is considered experimental and are advised to consult the current prescribing information for these products. The faculty is required to disclose their discussion of drugs or medical devices that are unlabeled, investigational, or not approved for the use that is being discussed. Faculty members have disclosed the following: H. Brent Solvason, PhD, MD             Will be discussing off-label augmentation strategies, thyroid, and dopamine agonists Shannon J. Drayton, PharmD, BCPP             Will be discussing off-label use of therapeutic agents Patrick R. Finley, PharmD, BCPP             Will not be discussing off-label uses  Back to top Abstracts: Adjunctive Treatment of Residual Symptoms in Resistant Depression H. Brent Solvason, PhD, MD Depression is a recurring and chronic illness that markedly impairs psychosocial function, and also affects physiological responses, as well as the outcomes of medical illnesses. While numerous studies demonstrate a relatively high response rate to currently effective antidepressant treatments, full remission, characterized by complete recovery, is considerably more difficult to achieve. For example, in the large NIMHfunded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, only one-third of patients achieved remission during Phase 1 of treatment with citalopram.  Residual symptoms, of which persistent fatigue, sleep dysfunction, and cognitive deficits, have important implications in the long-term functioning of major depressive disorder (MDD) and the prospects for recovery. Adjunctive medications or therapies are needed to treat residual symptoms in resistant depression. What can clinicians learn about adjunctive therapies from STAR*D?  The STAR*D trial explored sequential treatment strategies following an initial trial with citalopram. Patients who did not achieve remission with citalopram (Phase 1) were allowed to choose to enter a switch strategy or an augmentation/combination strategy in Phase 2. Combination/augmentation involved randomization to adding either busiprone or bupropion; these two produced similar remission rates. Switching involved randomization to bupropion, venlafaxine, or sertraline; all three were similar and were slightly less efficacious than the augmentation strategies. Since patients were only randomized within a strategy but not to a strategy, direct comparisons between augmentation and switch are not entirely feasible. Phases 3 and 4 involved a number of other augmentations (T-3 or lithium) or switches (e.g., tranylcypromine). Generally, remission rates in Phases 3 and 4 were lower than in Phases 1 and 2 suggesting the likelihood of responding is highest early in treatment. This presentation will review the role of adjunctive and augmentation strategies for the treatment of residual symptoms, especially in the context of the STAR*D trial. Monitoring of Efficacy and Potential Adverse Effects in Augmentation Approaches Shannon J. Drayton, PharmD, BCPP Augmentation agents used in the treatment of major depressive disorder (MDD) require both monitoring for efficacy and potential adverse effects. Measurement-based care (MBC) is an effective approach to monitoring severity of depressive symptoms and response to treatment.  Adverse effects are a primary cause of medication non-adherence, thus close monitoring is essential to optimizing therapy. Aside from lithium, many of the augmentation agents (eg, T3 and buspirone) used in STAR*D require infrequent monitoring.  Although second generation antipsychotics (SGAs) were not included in the STAR*D clinical trials they can be utilized as augmentation in MDD. SGAs require baseline and routine monitoring for short- and long-term adverse effects (eg, blood glucose and tardive dyskinsia). Monitoring for adverse effects and efficacy, via MBC, can improve patient outcomes and adherence to treatment. Expanding the Role of Pharmacists in the Care of Patients with Depression Patrick R. Finley, PharmD, BCPP Primary care physicians (PCPs) have taken increasing responsibility in caring for patients with depression. More than 70% of depressed patients are treated in the primary care setting and 77% of antidepressants prescribed are by PCP. However, depression treatment remains suboptimal. Just over half of depressed patients are receiving treatment and less than half of those treated patients are being adequately treated. Some of the barriers to optimized care are due to PCPs time constraints and the lack of familiarity in treating depression as well as the systemic limited access to mental healthcare. Pharmacists are the most accessible healthcare professional. With training in pharmacotherapy and patient education, pharmacists have an important role in caring for patients with depression. Further, pharmacists’ scope of practice and education has evolved to that of a patient-centered model thereby resulting in a greater collaborative drug therapy approach. An expanded role in depression care is supported by studies demonstrating effectiveness and improved outcomes. This presentation will review the evidence supporting pharmacists’ expanded role in the care of patients with depression as well as some of the models in practice.  Back to top Selected References: Adjunctive Treatment of Residual Symptoms in Depression H. Brent Solvason, PhD, MD Bauer M, Adli M, Baethge C, Berghöfer A, Sasse J, Heinz A, Bschor T. Lithium augmentation therapy in refractory depression: clinical evidence and neurobiological mechanisms. Can J Psychiatry. 2003;48(7):440-8. Berman RM, Marcus RN, Swanink R, McQuade RD, Carson WH, Corey-Lisle PK, Khan A. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2007;68(6):843-53. Carpenter LL, Yasmin S, Price LH. A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine. Biol Psychiatry. 2002;51(2):183-8. Castaneda AE, Suvisaari J, Marttunen M, Perälä J, Saarni SI, Aalto-Setälä T, Aro H, Koskinen S, Lönnqvist J, Tuulio-Henriksson A. Cognitive functioning in a populationbased sample of young adults with a history of non-psychotic unipolar depressive disorders without psychiatric comorbidity. J Affect Disord. 2008;110(1-2):36-45. DeBattista C, Belanoff J, Glass S, Khan A, Horne RL, Blasey C, Carpenter LL, Alva G. Mifepristone versus placebo in the treatment of psychosis in patients with psychotic major depression. Biol Psychiatry. 2006;60(12):1343-9. DeBattista C, Doghramji K, Menza MA, Rosenthal MH, Fieve RR; Modafinil in Depression Study Group. Adjunct modafinil for the short-term treatment of fatigue and sleepiness in patients with major depressive disorder: a preliminary double-blind, placebo-controlled study. J Clin Psychiatry. 2003;64(9):1057-64. DeBattista C, Posener JA, Kalehzan BM, Schatzberg AF. Acute antidepressant effects of intravenous hydrocortisone and CRH in depressed patients: a double-blind, placebocontrolled study. Am J Psychiatry. 2000;157(8):1334-7. Debattista C, Solvason HB, Belanoff J, Schatzberg AF. Treatment of psychotic depression. Am J Psychiatry. 1997;154(11):1625-6. Goldberg JF, Frye MA, Dunn RT. Pramipexole in refractory bipolar depression. Am J Psychiatry. 1999;156(5):798. Joffe RT, Sokolov ST. Thyroid hormone treatment of primary unipolar depression: a review. Int J Neuropsychopharmacol. 2000;3(2):143-147. Marraccini RL, Reynolds CF 3rd, Houck PR, et al. A double-blind, placebo-controlled assessment of nortriptyline's side-effects during 3-year maintenance treatment in elderly patients with recurrent major depression. Int J Geriatr Psychiatry. 1999;14(12):1014-8. McGrath PJ, Stewart JW, Fava M, et al. Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report. Am J Psychiatry. 2006 Sep;163(9):1531-41. Nierenberg AA, Keefe BR, Leslie VC, et al. Residual symptoms in depressed patients who respond acutely to fluoxetine. J Clin Psychiatry. 1999;60(4):221-5. Normann C, Hummel B, Schärer LO, Hörn M, Grunze H, Walden J. Lamotrigine as adjunct to paroxetine in acute depression: a placebo-controlled, double-blind study. J Clin Psychiatry. 2002;63(4):337-44. Papakostas GI, Shelton RC, Smith J, Fava M. Augmentation of antidepressants with atypical antipsychotic medications for treatment-resistant major depressive disorder: a meta-analysis. J Clin Psychiatry. 2007;68(6):826-31. Paykel ES, Ramana R, Cooper Z, Hayhurst H, Kerr J, Barocka A. Residual symptoms after partial remission: an important outcome in depression. Psychol Med. 1995 Nov;25(6):1171-80. Roberts RE, Shema SJ, Kaplan GA, Strawbridge WJ. Sleep complaints and depression in an aging cohort: A prospective perspective. Am J Psychiatry. 2000;157(1):81-8. Rush AJ, Fava M, Wisniewski SR, et al; STAR*D Investigators Group. Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Control Clin Trials. 2004;25(1):119-42. Rush AJ, Trivedi M, Fava M. Depression, IV: STAR*D treatment trial for depression. Am J Psychiatry. 2003;160(2):237. Thase ME, Corya SA, Osuntokun O, et al. A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, and fluoxetine in treatment-resistant major depressive disorder. J Clin Psychiatry. 2007;68(2):224-36. Trivedi MH, Fava M, Wisniewski SR, et al; STAR*D Study Team. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006;354(12):1243-1252. Trivedi MH, Rush AJ, Wisniewski SR, et al; STAR*D Study Team. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163(1):28-40. Zajecka J, Amsterdam JD, Quitkin FM, et al. Changes in adverse events reported by patients during 6 months of fluoxetine therapy. J Clin Psychiatry. 1999;60(6):389-94. Monitoring of Efficacy and Potential Adverse Effects in Augmentation Approaches Shannon J. Drayton, PharmD, BCPP American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologist, et al. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004;27:596-601. Anderson IM, Sarsfield A, Haddad PM. Efficacy, safety and tolerability of quetiapine augmentation in treatment resistant-depression: an open-label, pilot study. J Affective Disorders 2009;117:116-119. Berman RM, Marcus RN, Swanink R, McQuade RD, Carson WH, Corey-Lisle PK, and Khan A. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2007;68;6:843-853. Corya SA, Andersen SW, Holland CD, Kelly LS, Van Campen LE, Sanger TM, Williamson DJ, and Dube S. Long-term antidepressant efficacy and safety of olanzapine/fluoxetine combination: a 76-week open-label study. J Clin Psych. 2003;64:1349-1355. Corya SA, Williamson D, Sanger TM, et al. A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, fluoxetine, and venlafaxine in treatmentresistant depression. Depress Anxiety. 2006;23:364-372. Doree JP, Des RJ, Lew V, et al. Quetiapine augmentation of treatment-resistant depression: a comparison with lithium. Curr Med Res Opin.2007;23:333-341. Fuller MA, Sajatovic M (ed). Drug Information Handbook for Psychiatry. Hudson, OH, Lexi-Comp, 2007. Dunner DL, Amsterdam JD, Shelton RC, Loebel A, and Romano SJ. Efficacy and tolerability of adjunctive ziprasidone in treatment-resistant depression: a randomized, open-label, pilot study. J Clin Psych 2007;68:1071-1076. Hellerstein DJ, Batchelder S, Hyler S, Arnaout B, Corpuz V, Coram L, and Weiss G. Aripiprazole as an adjunctive treatment for refractory unipolar depression. Progress Neuro-Psychopharm Biol Psych 2008;32:744-750. Keitner GI, Garlow SJ, Ryan CE, Ninan PT, Solomon DA, Nemeroff CB, and Keller MB. A randomized, placebo-controlled trial of risperidone augmentation for patients with difficult-to-treat unipolar non-psychotic major depression. J Psych Res 2009;43:205-214. Mahmoud RA, Pandina GJ, Turkos I, Kosik-Gonzalez C, Canuso CM, Kujawa MJ, and Gharabawi-Garibaldi GM. Risperidone for treatment-refractory major depressive disorder: a randomized trial. Ann Intern Med 2007;147:593-602. Marcus RN, McQuade RD, Carson WH, Hennicken D, Fava M, Simon JS, Trivedi MH, Thase ME, and Berman RM. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a second multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychopharm 2008;28;2:156-165. Pae CU, Patkar AA, Jun TY, Lee C, Masand PS, and Paik IH. Aripiprazole augmentation for treatment of patients with inadequate antidepressants response. Depress Anxiety 2007;24:522-526. Papakostas GI, Petersen TJ, Kinrys G, Burns AM, Worthington JJ, Alpert JE, Fava M, and Nierenberg AA. Aripiprazole augmentation of selective serotonin reuptake inhibitors for treatment-resistant major depressive disorder. J Clin Psychiatry 2005;66:1326-1330. Papakostas GI, Petersen TJ, Nierenberg AA, Murakami JL, Alpert JE, Rosenbaum JF, and Fava M. Ziprasidone augmentation of selective serotonin reuptake inhibitors (SSRIs) for SSRI-resistant major depressive disorder. J Clin Psych 2004;65:217-221. Patkar AA, Peindl K, Mago R, Mannelli P, and Masand PS. An open-label, rater-blinded, augmentation study of aripiprazole in treatment-resistant depression. Prim Care Companion J Clin Psychiatry. 2006;8:82-87. Rapaport MH, Gharabawi GM, Canuso CM, Mahmoud RA, Keller MB, Bossie CA, Turkos I, Lasser RA, Loescher A, Bouhours P, Dunbar F, and Nemeroff CB. Effects of risperidone augmentation in patients with treatment-resistant depression: results of openlabel treatment followed by double-blind continuation. Neuropsychopharmacology 2006;31:2505-2513. Sagud M, Mihaljevic-Peles A, Muck-Seler D, et al. Quetiapine augmentation in treatment-resistant depression: a naturalistic study. Psychopharmacology. 2006;187:511-514. Shelton RC, Tollefson GD, Tohen M, Stahl S, Gannon KS, Jacobs TG, Buras WR, Bymaster FP, Zhang W, Spencer KA, Feldman PD, Meltzer HY. A novel augmentation strategy for treating resistant major depression. Am J Psych. 2001;158:131-134. Shelton RC, Williamson DJ, Corya SA, Sanger TM, Van Campen LE, Case M, Briggs SD, and Tollefson GD. Olanzapine/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance. J Clin Psych. 2005;66:1289-1297. Simon JS and Nemeroff CB. Aripiprazole augmentation of antidepressants for the treatment of partially responding and nonresponding patients with major depressive disorder. J Clin Psychiatry 2005;66:1216-1220. Thase ME, Corya SA, Osuntokun O, Case M, Henley DB, Sanger TM, Watson SB, and Dube S. A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, and fluoxetine in treatment-resistant major depressive disorder. J Clin Psych 2007;68:224-236. Trivedi MH, Thase ME, Osuntokun O, Henley DB, Case M, Watson SB, Campbell GM. Corya SA. An integrated analysis of olanzapine/fluoxetine combination in clinical trials of treatment-resistant depression. J Clin Psych 2009;70:387-96. Varusova L. Quetiapine in the Treatment of Non-Psychotic Depression (P.2 E 037). Int J Neuropsychopharmacol. 2002;5(Suppl 1). Yoshimura R, Umene-Nakano W, Ueda N, Ikenouchi-Sugita A, Hori H, and Nakamura J. Addition of risperidone to sertraline improves sertraline-resistant refractory depression without influencing plasma concentrations of sertraline and desmethylsertraline. Hum Psychopharmacol Clin Exp. 2008;23:707-713. Expanding the Role of Pharmacists in the Care of Patients with Depression Patrick R. Finley, PharmD, BCPP Finley PR. Depression and Medical Comorbidity – Treatment Considerations. Rx Consultant. 2004; 12:1-8. Keely JL; American College of Physicians-American Society of Internal Medicine. Pharmacist scope of practice. Ann Intern Med. 2002;136:79-85. Finley PR, Rens HR, Pont JT, et al. Impact of a collaborative care model on depression in a primary care setting: a randomized controlled trial. Pharmacotherapy. 2003;23:1175-1185. Kessler RC., Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003;289:3095-3105.  Back to top Educational Grantor: This activity is supported by an unrestricted educational grant from Bristol-Myers Squibb Company and Otsuka America Pharmaceutical, Inc.  Back to top Continuing Education Credit: The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. The ACPE provider number is 0447-9999-09-084-H04-P. To receive the 1.5 contact hours of continuing education credit, 0.15 Continuing Education Units (CEUs), pharmacists should complete the activity requirements and evaluation at the conclusion of the activity.   Back to top Program Eligibility: Release Date: December 21, 2009 Expiration Date: December 21, 2010

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