Antidepressant medication management

There seems to be considerable reluctance in some parts of the medical community to acknowledge the benefits of exercise in the treatment of depression. One meta-analysis of clinical trials showed that physical exercise was as effective as psychotherapy or antidepressant medication and much better than no treatment. But the authors concluded that the effectiveness of exercise in reducing symptoms of depression cannot be determined ,45 and the editors of the journal introduced the article with an editorial comment entitled effectiveness of exercise in managing depression is not shown by meta-analysis .46 Why not Because there were flaws in the way many of the studies had been designed. To be fair, there were indeed shortcomings in the studies, but these shortcomings also characterize clinical trials of antidepressants.47 If clinical trials like these do not establish the effectiveness of physical exercise as a treatment for depression, neither do they establish the effectiveness of antidepressants. 

For most children and adolescents, multimodal therapies are recommended. However, if antidepressant medications are used alone, psychosocial maintenance strategies should be implemented to help the patient manage inner and interpersonal conflicts, improve coping and social skills, deal with the psychosocial and personal scars left by the depression, and improve academic and social functioning. The reduction of family stress, promotion of a supportive environment, and the effective treatment of parents and siblings with psychiatric disorders may also help diminish the risk for... 

Psychiatric illness occurs in 50% of the population over the course of a lifetime and nearly 30% over the course of a yearJ" It affects all age groups and causes significant morbidity, mortality, and diminished quality of lifeJ" Medication management is essential to treat acute symptoms of psychiatric illness and to prevent relapse. In fact, psychotropic drugs (antidepressants, anti-psychotics, anxiolytics, hypnotics mood stabilizers, stimulants) comprised 10% of the top 200 brand name and generic drugs dispensed from retail pharmacies in the year 2001. ... 

The optimal duration of antidepressant treatment is unknown, but most clinicians will continue them for 6 to 12 months in patients who respond and then re-evaluate the need for ongoing medication management. The long-term course is variable, but there is the potential for a fatal outcome from cardiac arrest or suicide. 

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

Management of Agitation and Psychosis. Like antidepressants, mood stabilizers do not work immediately. It often takes a week or longer for a mood stabilizer to reach a therapeutic level and exert its beneficial treatment effects. Meanwhile, one may have a labile, impulsive, and agitated patient on one s hands. Clearly, rapidly acting tranquilizing medications are needed at this juncture to calm an agitated patient. 

The few controlled studies of pharmacotherapy for AN have largely been disappointing. No class of medication has consistently proved effective in the treatment of AN consequently, pharmacotherapy plays a relatively minor role in the routine management of the disorder. Nevertheless, a review of the medications tested for the treatment of AN is informative. Medications used in the treatment of AN include appetite stimulants, antidepressants, antipsychotics, anxiolytics, trace mineral supplementation, prokinetics, and opiate antagonists. 

Unlabeled Uses Augmenting medication for antidepressants management of aggression in mental retardation and secondary mental disorders, major depression, panic attack... 

Assessment of physical, as well as psychiatric status, is also critically important. The presence of intercurrent medical disorders, as well as any medication used to manage them, increases the likelihood of an adverse outcome with an otherwise appropriate medication. With a recent history of myocardial infarction, certain tricyclic antidepressants (TCAs) or low-potency antipsychotics might be contraindicated due to potential adverse effects on cardiac function. Another example is the avoidance of carbamazepine in a bipolar patient with a persistently low white blood cell count. Finally, b-blockers are typically contraindicated in a patient with asthma. 

Long-Term Efficacy Clonazepam has been shown to be effective for long-term use to manage PD or agoraphobia with panic attacks. In a 1-year follow-up study of clonazepam for PD or agoraphobia with panic attacks. Pollack et al. (42) reported that 18 of 20 (90%) patients, many of whom had failed to respond to or tolerate other BZDs or antidepressants, maintained a good response. One patient was in complete remission at 44 weeks and remained well even off medication at 56 weeks. Tolerance to therapeutic efficacy did not appear to develop, although 40% required a dose increase (from 0.25 to 4.5 mg) to maintain initial improvement. 

Hallucinogens, for example, LSD and magic mushrooms, have always been in the background of the drug culture. The management in the acute stages may need hospitalisation and treatment with neuroleptics and settles quickly. There is no place for any medication after this unless specific psychiatric symptoms have been detected which may respond to anxiolytics, antidepressants or major neuroleptics. A full support mechanism through a number of channels needs to be set up around the individual. 

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