Antidepressant Strategies for Treatment of Acute Depressive Episodes Among Veterans.

OBJECTIVE: The 2016 VA/DoD Clinical Practice Guideline for Management of Major Depressive Disorder offers consensus-based recommendations when response to the initial antidepressant medication is suboptimal; however, little is known about "real-world" pharmacological strategies used by providers treating depression in the Veterans Affairs Health Care System (VAHCS). METHODS: We extracted pharmacy and administrative records of patients diagnosed with a depressive disorder and treated at the Minneapolis VAHCS between January 1, 2010 and May 11, 2021. Patients with bipolar disorder, psychosis-spectrum, or dementia diagnoses were excluded. An algorithm was developed to identify antidepressant strategies: monotherapy (MONO); optimization (OPM); switching (SWT); combination (COM); and augmentation (AUG). Additional data extracted included demographics, service utilization, other psychiatric diagnoses, and clinical risk for hospitalization and mortality. RESULTS: The sample consisted of 1298 patients, 11.3% of whom were female. The mean age of the sample was 51 years. Half of the patients received MONO, with 40% of those patients receiving inadequate doses. OPM was the most common next-step strategy. SWT and COM/AUG were used for 15.9% and 2.6% of patients, respectively. Overall, patients who received COM/AUG were younger. OPM, SWT, and COM/AUG occurred more frequently in psychiatric services settings and required a greater number of outpatient visits. The association between antidepressant strategies and risk of mortality became nonsignificant after accounting for age. CONCLUSIONS: Most of the veterans with acute depression were treated with a single antidepressant, while COM and AUG were rarely used. The age of the patient, and not necessarily greater medical risks, appeared to be a major factor in decisions about antidepressant strategies. Future studies should evaluate whether implementation of underutilized COM and AUG strategies early in the course of depression treatment are feasible.

Long-term frequency aging for unpowered space-class oscillators.

Very little data exists regarding the long-term aging performance of space-rated oscillators in the non-operating mode. This paper provides empirical evidence that may be used to estimate the performance of unpowered oscillators for long-term space missions, as well as an aid in validating the worst-case analyses that are routinely performed on these oscillators. The proper operation of any space vehicle is dependent on the performance of the onboard master oscillator. For maximum reliability, the onboard clock is often provided as a dual-or triple-redundant ensemble, with one active oscillator. The backup oscillator(s) are usually powered off and may be off for a significant percentage of the mission. A significant parameter of importance for oscillator performance is the aging rate. Papers have been presented on the aging performance of active oscillators in space, but very little data exists regarding the long-term aging performance of oscillators in the nonoperating mode. The aging rate data are extremely important for predicting the expected performance of these backup oscillators after 10 or 15 years in of non-operation in space. This paper presents performance data derived from temperature controlled crystal oscillators and oven controlled crystal oscillators that have been dormant for decades.