The Journal of clinical psychiatry
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Severe mental illness and obesity are each serious public health problems that overlap to a clinically significant extent. Unfortunately, some of the most effective medications for severe mental illness are associated with the greatest weight gain, and the most effective strategy for severe obesity, bariatric surgery, is a treatment of last resort. ⋯ If drugs with weight-inducing effects must be used, emerging data indicate that behavioral weight management, if not already in place, should be implemented and that adjunctive pharmacotherapeutic strategies should be considered. Severe mental illness with obesity must be viewed as 2 chronic illnesses that each require long-term management.
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Despite the multitude of agents approved for the treatment of major depressive disorder, approximately 50% of patients experience no response to treatment with a first-line antidepressant. Clinicians have 4 broad pharmacologic strategies to choose from for treating antidepressant nonresponders: increasing the dose of the antidepressant, switching to a different antidepressant, augmenting the treatment regimen with a nonantidepressant agent, and combining the original antidepressant with a second antidepressant. To date, the most comprehensively studied treatment strategy for nonresponse or partial response to antidepressants is augmentation with atypical antipsychotic agents, including aripiprazole, olanzapine, quetiapine, and risperidone. ⋯ Clinicians should carefully reevaluate patients with major depressive disorder who are nonresponders to treatment, particularly those who have had several adequate trials. When choosing the best treatment strategy for antidepressant nonresponders, clinicians should take into account the efficacy and tolerability of treatment as well as patient preference and treatment history. Finally, the risk of potential loss of partial therapeutic benefit from the first-line antidepressant, as well as the risk of withdrawal symptoms, should be taken into account when considering switching antidepressants, while the risk of drug interactions and poor adherence should be taken into account when considering combination and augmentation treatments.