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Table 1 Messages delivered during detailing session

From: A pilot study evaluating alternative approaches of academic detailing in rural family practice clinics

Phase I

Treatment-resistant Depression in the Primary Care Setting

· Formulate a treatment plan at the start of therapy

· Prior to switching or augmenting an antidepressant consider a longer trial (12–14 weeks) at a therapeutic dose

· Triiodothyronine (T3, cytomel) is an effective and well tolerated augmentation agent

Use of Atypical Antipsychotics in Treatment –resistant Depression

· Consider T3 (or lithium) prior to considering atypical antipsychotic augmentation agent

· Atypical antipsychotics are associated with metabolic abnormalities and require regular monitoring

Phase II

Pharmacotherapy options for Insomnia

· Cognitive behavior therapy and pharmacologic treatment approaches have similar effectiveness

· All sedative/hypnotics appear to be comparable in treating insomnia

· Clinical data regarding sedating antidepressants and antipsychotics are lacking

Clinical use and comparative effectiveness of benzodiazepines

· Long-term benzodiazepine use is rarely warranted

· Withdrawal of benzodiazepine has led to improvements in cognitive functioning, balance, and memory without worsening insomnia (particularly in frail elderly)

· Discontinuation should always include gradual tapering