Antidepressant drugs history

Patients whose depression has apparently been resistant to standard antidepressant treatment often have had inadequate trials of antidepressants or have been nonadherent with drug therapy. Depression in a patient who has failed to complete an adequate trial of an antidepressant drug does not constitute treatment-resistant depression. A patient who reports a history of robust but short-lived responses to several antidepressants may be manifesting a medication-induced rapid-cycling course. Mild episodes of hypomania during the course of treatment may be overlooked, especially in a productive patient with a high level of functioning and a premorbid history of hyperthymic personality, defined as a chronic state of mild hypo-mania. In these cases, treatment with a mood stabilizer is indicated (see Chapter 5). 

Fused tricyclic compounds have a venerable history as antidepressant drugs. A number of carbocyclic representatives are considered in Chapter 3 while those that consist of dibenzo heterocyclic compounds are noted in Chapter 13. Antidepressant activity is retained in a benzodiazepine in which the third ring occurs in an unfused... 

Shorter, Edward. How Prozac Slew Freud. American Heritage 49, no. 5 (September 1998) 42-44. In this brief history of psychiatry, the author examines remarkable changes in the treatment of mental illness. Rather than treating problems with drawn-out therapy, psychiatrists most often end a patient visit with a prescription to antidepressant drugs like Prozac. The article illustrates the wide-ranging impact over the last several decades of new prescription drugs. 

Yohimbine can cause hypertension in patients taking tricyclic antidepressants. A drug history should include the use of herbal remedies before conventional treatments are prescribed. 

Regulation of mood, sleep, and aggression have all been shown to involve the serotoninergic system (17-19), and most antidepressant drugs currently being used inhibit 5-HT reuptake and/or act on 5-HT receptors (of which there are several subtypes). 5-HT is produced centrally from the amino acid tryptophan, and depressed mood can be induced experimentally by acute tryptophan depletion in healthy individuals. This effect is accentuated in those with a family history of depression (18-21). Similarly, depressive relapse can be initiated in individuals treated with MAO inhibitors or selective serotonin reuptake (SSRI) inhibitors by depleting tryptophan (22, 23). 

Three cases of nefopam abuse have been reported (3). The patients had the same pattern of a history of chronic pain, concomitant anxioljdic and antidepressant drug therapy, and abuse of nefopam due to its primarily psy-chostimulant-like symptoms. The recommended dose of nefopam is 20 mg intramuscularly every 6 hours, with a maximum recommended dose of 120 mg/day. Daily consumption in the three patients was 120-1840 mg/day. 

Many patients with BED display symptoms of, or have a past history of depressive disorder, and a number of different antidepressant drugs, mainly of the serotonin reuptake inhibitor type (SSRI) have been tried in its treatment (Carter et al. 2003). 

While the SSRIs are the most frequently used drugs for treatment of major depressions, the tricyclics remain valuable alternatives. In some patients a tricyclic may be the first choice, especially if the past history indicates a positive therapeutic response to such drugs. The sedative actions of tricyclics may be of value in depressed patients with insomnia or weight loss, since SSRIs tend to exacerbate such symptoms. Generic formulations of the tricyclics are much less costly than any of the other antidepressant drugs. 

The MAOI antidepressant drag s are contraindicated in patients widi known hypersensitivity to die drug s, liver and kidney disease, cerebrovascular disease, hypertension, or congestive heart failure and in die elderly. These drag s are given cautiously to patients witii impaired liver function, history of seizures, parkinsonian symptoms, diabetes, or hyperthyroidism. 

Ciraulo DA, Jaffe JH Tricyclic antidepressants in the treatment of depression associated with alcoholism. Clin Psychopharmacol 1 146—150, 1981 Ciraulo DA, Nace E Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict 9 276—284, 2000 Ciraulo DA, Barnhill JG, Jaffe JH, et al Intravenous pharmacokinetics of 2-hydroxy-imipramine in alcoholics and normal controls. J StudAlcohol 51 366-372, 1990 Ciraulo DA, Knapp CM, LoCastro J, et al A benzodiazepine mood effect scale reliability and validity determined for alcohol-dependent subjects and adults with a parental history of alcoholism. Am J Drug Alcohol Abuse 27 339—347, 2001 Collins MA Tetrahydropapaveroline in Parkinson s disease and alcoholism a look back in honor of Merton Sandler. Neurotoxicology 25 117-120, 2004 COMBINE Study Research Group Testing combined pharmacotherapies and behavioral interventions in alcohol dependence rationale and methods. Alcohol Clin Exp Res 27 1107-1122, 2003a... 

How is it that the chemical-imbalance theory was proposed and so widely accepted, when the only controlled scientific study that had been done indicated that one could relieve depression, rather than induce it, by giving patients a drug that increases brain levels of monoamines David Healy, in his comprehensive treatise on the history of antidepressants, provides an answer to this question.19 The study was simply ignored, despite having been published in The Lancet, one of the world s most prestigious medical journals. 

I suppose that some ingenious minds will be able to find a way of accommodating the chemical-balance hypothesis to these data, but I suspect that the accommodation will require convoluted circumventions, like those used by the Flat Earth Society in their efforts to maintain their defunct theory in the face of photographic evidence from space. If depression can be equally affected by drugs that increase serotonin, drugs that decrease it and drugs that do not affect it at all, then the benefits of these drugs cannot be due to their specific chemical activity. And if the therapeutic benefits of antidepressants are not due to their chemical composition, then the widely proffered chemical-imbalance theory of depression is without foundation. It is an accident of history produced serendipitously by the placebo effect. 

BZs are second-line agents except when rapid response is essential. They should not be used as monotherapy in panic disorder patients with a history of depression or alcohol or drug abuse. BZs are often used concomitantly with antidepressants in the first weeks to offset the delay in onset of antipanic effects. 

Lithium is effective for acute mania, but it may require 6 to 8 weeks to show antidepressant efficacy. It may be more effective for elated mania and less effective for mania with psychotic features, mixed episodes, rapid cycling, and when alcohol and drug abuse is present. Maintenance therapy is more effective in patients with fewer episodes, good functioning between episodes, and when there is a family history of good response to lithium. It produces a prophylactic response in up to two-thirds of patients and reduces suicide risk by eight- to 10-fold. 

Factors that influence the choice of antidepressant include the patient s history of response, history of familial response, concurrent medical conditions, presenting symptoms, potential for drug-drug interactions, comparative side-effect profiles of various drugs, patient preference, and drug cost. 

Drug Interactions. No modern discussion of the history of antidepressants would be complete without mention of the debate regarding potential drug interactions. As discussed more fully in Chapter 2, medications may interact in several ways, and their interactions may be helpful or harmful. The antidepressant debate has focused on the way these drugs influence the liver s ability to metabolize and thus deactivate other drugs. In particular, it is the impact of antidepressants on the liver s cytochrome P450 family of enzymes that has been so extensively discussed. 

It is one of the ironies of Mike s long history with medications that only the very first drug he took gave him sustained relief At that time the drugs most commonly prescribed for depression belonged to a class known as tricyclic antidepressants, one of the earliest of which was... 

This case report (Figures 6-4Ato 6-4C) (McDermut et al. 1995) of selective response to dihydropyridine CCBs but not a phenylalkylamine CCB is of considerable interest in relationship to the patient s history of nonre-sponsivity to multiple tricyclic antidepressants, the selective serotonin reuptake inhibitors, lithium, carbamazepine (the patient developed drug-induced hepatitis on carbamazepine and was unable to be evaluated), alprazolam, trazodone, and phenelzine. This suggests that patients with refractory mood disorders may have differential responses to various CCBs and that nonresponse to one CCB does not preclude response to another CCB, particularly if the other CCB is from a different category (Table 6-3). 

The commonly used classes of antidepressants are discussed in the following sections, and information about doses and half-lives is summarized in Table 2-1. The antidepressant classes are based on similarity of receptor effects and side effects. All are effective against depression when administered in therapeutic doses. The choice of antidepressant medication is based on the patient s psychiatric symptoms, his or her history of treatment response, family members history of response, medication side-effect profiles, and comorbid disorders (Tables 2-2 and 2-3). In general, SSRIs and the other newer antidepressants are better tolerated and safer than TCAs and MAOIs, although many patients benefit from treatment with these older drugs. In the following sections, clinically relevant information is presented for the antidepressant medication classes individually, and the pharmacological treatment of depression is also discussed. The use of antidepressants to treat anxiety disorders is addressed in Chapter 3. 

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