Depression continuation therapy

Coppen A, Ghose K, Montgomery S, et al Continuation therapy with amitriptyline in depression. Br J Psychiatry 133 28-33, 1978 Coppen A, Swade C, Wood K Lithium restores abnormal platelet 5-HT transport in patients with affective disorders. Br J Psychiatry 136 235-238, 1980 Coppen A, Swade C, Jones SA, et al Depression and tetrahydrobiopterin the folate connection. J Affect Disord 16 103-107, 1989 Cordell B 3-Amyloid formation as a potential therapeutic target for Alzheimer s disease. Annu Rev Pharmacol Toxicol 34 69-89, 1994 Corkin S Acetylcholine, aging, and Alzheimer s disease imphcations of treatment. Trends Neurosci 4 287-290, 1981... 

Glen AIM, Johnson AL, Shepherd M Continuation therapy with lithium and amitriptyline in unipolar depressive illness a randomized double-blind controlled trial. Psychol Med 14 37-50, 1984... 

Controlled discontinuation trials show that about half of all depressive patients suffer a serious relapse within 6 months if their antidepressant medication is withdrawn shortly after the disappearance of acute symptoms with continuation therapy, only about one-fifth of patients experience a relapse in the same period. The difficulty for the treating doctor is to estimate reliably how long he should continue to prescribe antidepressants for patients who have overcome depression. Consensus groups suggest that this period should be between four and six months after the symptoms of depression have resolved (Montgomery, 1997) even mild continuing symptoms may indicate that a depressive episode has not ceased completely and that the treatment should be continued further (Lader, 2001). 

Reimherr, F.W., Amsterdam, J.D., Quitkin, F.M., et al. Optimal length of continuation therapy in depression a prospective assessment during long-term fluoxetine treatment. Am. J. Psychiatry 155, 1247-1253, 1998. 

Mindham RHS, Howland C, Shepherd M. An evaluation of continuation therapy with tricyclic antidepressants in depressive illness. Psychol Med 1973 3 5-17. 

Georgotas A, McCue RE. Relapse of depressed patients after effective continuation therapy. J Affect Disord 1989 17 159-164. 

Clarke TB, Coffey EC, Hoffman GW, et al. Continuation therapy for depression using outpatient ECT. Convuls Ther 1989 5 330-337. 

In a study of the use of phenelzine in continuation therapy after recovery from an acute episode of depression, relapse rates were higher in patients subjected to tapered withdrawal than in those who continued taking the therapeutic dose (8). 

A double-blind, placebo-controlled trial of the use of lithimn to augment antidepressant medication for treating unipolar major depression has shown it to be beneficial for patients receiving continuation therapy following acute therapy for a major depressive episode. The 14 patients in the lithium-treated group suffered no relapses over 4 months, while seven of the 15 patients in the placebo-treated group experienced relapses including one suicide. ... 

The efficacy and tolerability of topiramate have been studied in 170 patients with refractory epilepsy (7). The most common adverse effects resulting in withdrawal were fatigue, weight loss, irritability, paresthesia, depression, and headache. Three patients developed renal calculi but continued therapy. 

Drug Acute Mania or Mixed States Acute Bipolar Depression Continuation or Maintenance Therapy... 

In summary, Cu therapy administered according to recommended doses was effective and did not as a rule cause untoward reactions. Onset of improvement was immediate, definite and progessive in most patients. Twelve patients were followed for over 2 yr and showed no relapse. It was felt that this period was long enough to make it unlikely that these were spontaneous remissions. Erythrocyte sedimentation rates returned to normal faster in patients with RA of less than 1 yr duration than in those with chronic disease. Fifty-one of 59 patients experienced no ill-effect attributable to the medication. Only minor side effects, such as malaise, nausea and slight albuminuria were noted in 8 patients. No signs of marrow depression were noted in these 8 patients. Copper compounds used to continue therapy in patients who were resistant or intolerant to Au therapy were found to be advantageous since they were used without ill-effects in the event of Au therapy-induced dermatitis (rashes or stomatitis) or nephritis (albuminuria). 

Promoting an Optimal Response to Therapy Superficial and deep fungal infections respond slowly to antifungal therapy. Many patients experience anxiety and depression over the fact that therapy must continue for a prolonged time Depending on the method of treatment, patients may be faced with many problems during therapy and therefore need time to talk about problems as they arise Examples of problems are the cost of treatment, hospitalization (when required), the failure of treatment to adequately control the infection, and loss of income. The nurse must help the patient and the family to understand that therapy must be continued until tlie infection is under control. In some cases, therapy may take weeks or months. 

Fhtients receiving long-term opioid therapy rarely have problems with respiratory depression. In instances where respiratory depression occurs, administration of a narcotic antagonist (see Chap. 20) may be ordered by die primary health care provider if die respiratory rate continues to fall. 

In patients with NSTE ACS scheduled for early PCI, administration of either abciximab or eptifibatide (double bolus) is recommended. The use of tirofiban in these patients is not recommended, because it has been shown to be inferior to abciximab.2 Medical therapy with glycoprotein Ilb/IIIa receptor inhibitors in patients not undergoing PCI is reserved for higher-risk patients, such as those with positive troponin or ST-segment depression, and patients who have continued or recurrent ischemia despite other antithrombotic therapy.2... 

Since the typical major depressive episode lasts 6 months or longer, if antidepressant therapy is interrupted for any reason following the acute phase, the patient may relapse into the depressive episode. When treating the first depressive episode, antidepressants must be given for an additional 4 to 9 months in the continuation phase for the purpose of preventing relapse. 

Each antidepressant has a response rate of approximately 60% to 80%, and no antidepressant medication or class has been reliably shown to be more efficacious than another 22 MAOIs may be the most effective therapy for atypical depression, but MAOI use continues to wane because of problematic adverse effects, dietary restrictions, and possibility of fatal drug interactions.22,28 There is some evidence that dual-action antidepressants, such as TCAs and SNRIs, may be more effective for inpatients with severe depression than are the single-action drugs such as SSRIs,22,28 but the more general assertion that multiple mechanisms of action confer efficacy advantages is quite controversial.33... 

Duration of antidepressant therapy is also an unsettled question. It may be possible in some patients to prevent depressive relapse with a mood-stabilizing drug without maintenance antidepressant therapy following acute treatment with an antidepressant. If so, the risk of a mood switch with continued antidepressant therapy would be reduced. 

The answer is a. (Hardman, pp 885-8870 Lovastatin should not be used in patients with severe liver disease. With routine use of lovastatin, serum transaminase values may rise, and in such patients the drug may be continued only with great caution. Lovastatin has also been associated with lenticular opacities, and slit-lamp studies should be done before and one year after the start of therapy There is no effect on the otic nerve. The drug is not toxic to the renal system, and reports of bone marrow depression are very rare There is a small incidence of myopathy, and levels of creatinine kinase should be measured when unexplained muscle pain occurs. Combination with cyclosporine or clofibrate has led to myopathy There is no danger in use with bile acid sequestrants. 

Shock Therapy. Insulin coma treatments were used in the early 1900s but offered no tangible improvement. Electroconvulsive therapy (ECT) arose in the 1930s and 1940s and was the hrst treatment to provide some relief from psychosis. However, its effects are only temporary and it proved too costly for continuous use. ECT continues to have some use for life-threatening catatonia, but it is mainly used to treat refractory depression or bipolar disorder. 

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