Antidepressants emotional disorders

Other indications for the use of antipsychotics include Tourette s syndrome, disturbed behavior in patients with Alzheimer s disease, and, with antidepressants, psychotic depression. Antipsychotics are not indicated for the treatment of various withdrawal syndromes, eg, opioid withdrawal. In small doses, antipsychotic drugs have been promoted (wrongly) for the relief of anxiety associated with minor emotional disorders. The antianxiety sedatives (see Chapter 22) are preferred in terms of both safety and acceptability to patients. 

Flistrionic personality disorder is similar to the syndrome that Liebowitz and Klein ( 259) have termed hysteroid dysphoria or atypical depression. MAOIs have proven to be very helpful in this condition and these data are reviewed in Chapter 7. As noted earlier, Rifkin et al. (242) also investigated the effects of antidepressants in patients with emotionally unstable personalities, a syndrome characterized by excitability and ineffectiveness when confronted with minor stress. This syndrome is primarily found in female adolescents whose moods consist of the following ... 

Depression as an emotion is common and usually short-lived. As a symptom it can occur in most psychiatric disorders as well as other medical conditions, e.g. hypothyroidism, Parkinson s disease. As an illness, major depressive disorder (MDD), it is less common but, nevertheless, moderate to severe forms affect 5-10% of people in their lifetime and milder forms 20-30%. After a first episode, prophylaxis is required for at least 6 months and ideally 12 months to prevent relapse. This should usually be with the dose of antidepressant to which the patient initially responded. Those with recurrent episodes require prophylaxis over many years. 

The NE system mediates various autonomic, neuroendocrine, emotional and cognitive functions. One of the central roles of NE is response to stress and aversion. This role can be summarized as an activation of response to the acute stress and aversion, followed by decreased reaction to repeated or chronic aversion. Since the response to stress and aversion is a basic part in pathology of mood disorder, NE should play an important role in anxiety, depression and mania. Indeed, this role has been demonstrated in numerous animal and human studies. Majority of antidepressant drugs and mood stabilizers affect NE system as their direct or indirect target. Various medications have different effects on NE neuronal activity. The majority of antidepressants, Li and benzodiazepines suppress NE transmission. Other medications, such as AADs, activate NE neuronal firing activity and NE release. Appropriate combination of different medications, based on the consideration of their effect on NE system, might be critical to obtain good treatment outcome. The combination of SSRIs... 

Affective and Mental Disorders. Anxiety and emotional instability can be associated with psychogenic reactions, such as vasovagal syncope, that may appear to be drug related. Medications used to treat these disorders may potentiate the activity of ophthalmic medications. The use of monoamine oxidase inhibitors or tricyclic antidepressants can enhance the systemic effects of topically applied phenylephrine and a2-adrenergic agonists. 

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