Antidepressants problems associated with

Those who fail to respond to an SSRI may respond to a TCA, and vice versa. Thus, these two broad-spectrum classes can be used in a sequential strategy to adequately treat the majority of cases. However, many physicians try another newer antidepressant (e.g, venlafaxine, bupropion, nefazodone) in such patients because of the safety and tolerability problems associated with TCAs. Of note, the tolerability profile of secondary amine TCAs such as desipramine is as favorable as any of the newer antidepressants and probably better than nefazodone. Nevertheless, the secondary amine TCAs have a therapeutic index as narrow as tertiary amine TCAs (e.g., amitriptyline, imipramine) in terms of lethality in overdoses resulting from cardiotoxicity. 

MAO inhibitor tranylcypromine, for example, has been used since the 1960s as an antidepressant. A problem associated with many MAO inhibitors is that they are notoriously nonselective and can interfere with the metabolism of other neurotransmitters, amines found in certain foods, and exogenously administered amine-containing therapeutic agents. 

There is a large evidence base for the antidepressant efficacy of venlafaxine, but fewer studies have been carried out in anxiety disorders. The best evidence is for GAD (Allgulander et al. 2001) and anxiety symptoms associated with depression (Silverstone and Ravindran 1999). Side-effects on initiation of therapy are similar to those of SSRIs, with nausea being the most common. Higher doses can cause raised blood pressure. A discontinuation syndrome similar to that seen with SSRIs has been reported. Toxicity causes cardiac conduction problems, seizures and coma, and venlafax-... 

It is likely that depression and anxiety disorders are associated with problems in several brain systems, and, indeed, different drugs appear to be effective in different people. Even though SSRIs are currently the first choice of drugs for treating many anxiety disorders, other classes of antidepressants are tried if the SSRIs prove ineffective. 

Hyponatmemia is common with the thiazides and to a lesser extent with the loop diuretics. It occurs when the osmolality of the urine persistently exceeds that of the fluid intake and is associated with the inability of the kidney to produce a dilute urine. It is not usually severe. The origin is multifactorial and involves unrestricted fluid intake and increased ADH activity due to volume depletion. Co-administration of dipsogenic drugs, such as the tricyclic antidepressants, or those with ADH-like effects, such as chlorpropamide, can exacerbate the problem. There are rare occasions when hyponatraemia (Nan- concentration less than 100 mmol-L-l) can be of sufficient severity to be life threatening. 

Problems and side effects associated with buspirone include dizziness, headache, nausea, and restlessness. Antidepressants such as paroxetine and venlafaxine also produce a number of side effects (described in Chapter 7) depending on the specific agent. Nonetheless, these newer, nonbenzodiazepine... 

Depressive illness constitutes one of the most frequently seen mental disorders. The morbidity and mortality associated with alteration of mood is one of the major problems facing behavioral health professionals, with the U.S. National Comorbidity Study of 1994 showing a lifetime prevalence of major depression of 12.7 percent in males and 21.3 percent in females. Most mood disorders are chronic and require long-term management. Pharmacotherapy continues to be a mainstay treatment of depression. Because depressant mood disorders are so prevalent in our society, antidepressant drugs are among the most frequently prescribed medications. 

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