Antidepressant-responsive condition

It is being recognized increasingly that regulation can have a positive impact on laboratory productivity.36 System suitability testing has been proposed as superior to and supplemental to calibration in the UV-VIS detector.37 Large variations in both response factor and in relative response factors were observed on different instruments. Even on the same instrument, UV-VIS spectra can be extremely dependent on solution conditions, as was observed in a separation of hypericin, the antidepressant extract of St. John s wort.38... 

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. 

Schizoaffective disorders have depression or mania as a major component in addition to psychosis. Thus, lithium or an antidepressant may have to be added to the regimen. Antipsychotic agents are also used in the initial therapy of mania because the patient s response is more rapid than with lithium. As the condition subsides, the antipsychotic can be withdrawn. 

Conversely, many patients have psychiatric conditions that require the concomitant use of several psychotropic agents. The carefully considered, rational use of several psychiatric medications must be distinguished from ill-considered polypharmacy. An example of useful combined treatment is the addition of lithium to antidepressant therapy in the case of a patient who has achieved only a partial response to treatment with an antidepressant alone. 

Data support its usefulness in conditions not typically responsive to other antidepressants, specifically adult attention deficit hyperactivity disorder (ADHD) ( 169) and smoking cessation (170). 

To this list, we would add delusional (or psychotic) depression (see also Chapter 6 and Chapter 7). Whereas some have suggested that pre-ECT nonresponse to adequate pharmacotherapy is a powerful factor for predicting nonresponse to ECT ( 39, 40), others have argued for its superiority over antidepressants (alone or in combination with antipsychotics) for prior drug-nonrespon-sive nonpsychotic or psychotic depressions ( 41, 42 and 43). Support for this latter position comes from the discussion by Schatzberg and Rothschild ( 44), who separate this condition from other depressive disorders, in part because of its differential responsivity to various treatments. 

Over the years, antidepressant drugs have become an important treatment option in chronic pain states, in their own right and as adjuncts to opiate treatment. In fact, tricyclic antidepressants are the mainstay of treatment of neuropathic pain conditions such as polyneuropathy, diabetic neuropathy, postherpetic neuralgia and peripheral nerve injury (Sindrup, 1997 Sindrup and Jensen, 1999). Other chronic pain states responsive to antidepressants include osteo- and rheumatoid arthritis, fibromyalgia, and chronic tension headache. 

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