Depression or dementia

Other claims for megadoses of nicotinic acid or nicotinamide, such as the claim that abnormalities associated with schizophrenia, Down s syndrome, hyperactivity in children, etc. can be reduced, have so far failed to win general acceptance. Clearly niacin deficiency or dependency can exacerbate some types of mental illness such as depression or dementia. There have been a number of attempts to treat depression with tryptophan or niacin, or both, on the basis that the correction of depressed brain levels of serotonin would be advantageous. However, these have met with only limited success. Schizophrenics have been treated with nicotinic acid on the basis that their synthesis of NAD is impaired in some parts of the brain, and that the formation of hallucinogenic substances such as methylated indoles may be controlled. 

The miscellaneous anticonvulsants are contraindicated in patients with known hypersensitivity to any of the dru. Carbamazepine is contraindicated in patients with bone marrow depression or hepatic or renal impairment and during pregnancy (Category D). Valproic acid is not administered to patients with renal impairment or during pregnancy (Category D). Oxcarbazepine (Trileptal), a miscellaneous anticonvulsant, may exacerbate dementia... 

Leonard, B. E. Myint, A. (2006). Changes in the immune system in depression and dementia causal or coincidental effects Dialogues Clin. Neurosc., 8(2), 163-74. 

Information about prescription drag use alcohol or other substance use family medical history and history of trauma, depression, or head injury should be obtained. It is important to rule out medication use as a contributor or cause of symptoms (e.g., anticholinergics, sedatives, hypnotics, opioids, antipsychotics, and anticonvulsants) as contributors to dementia symptoms. Other medications may contribute to delirium, e.g.,... 

Reconsider diagnosis and rule out other conditions such as depression or a dementia other than Alzheimer disease... 

Barriers to compliance must be identified during the history. Emotions, cognitive function, and physical ability can affect patient adherence to therapy. If a patient suffers from depression (emotional barrier), schizophrenia or dementia (cognitive barrier), or severe arthritis of the hands (physical barrier), compliance can diminish. Special attention should be given to these three areas, and barriers should be indicated on the history record. This process directs the implementation of specific aids to improve compliance. 

Women are more likely to have mixed states, depressive episodes, and rapid cycling compared to men. Onset of manic episodes after the age of 60 is rare and is likely caused by a medical or neurological condition (e.g., stroke, tumor, or dementia), medications, or substance use. ... 

One of the biggest problems for many clinical professionals who work with these clients is the lack of clarity and problems in semantics in defining what the term depression actually means. For many individuals, depression can mean feeling sad, blue, or down in the dumps, whereas for others there are clearly established criteria that reflect consistent patterns, signs, and symptoms relative to a mood disorder (Gitlin, 19%). Furthermore, some form of depression (also referred to as dysphoric mood) is present in virtually all mental health conditions. The only possible exceptions to this are clients who suffer from mania, certain forms of schizophrenia, or dementia (Gitlin, 1996). 

The psychotic disorders include schizophrenia, the manic phase of bipolar (manic-depressive) illness, acute idiopathic psychotic illnesses, and other conditions marked by severe agitation. All exhibit major disturbances in reasoning, often with delusions and hallucinations. Several classes of drugs are effective for symptomatic treatment. Antipsychotic agents also are useful alternatives to electroconvulsive therapy (ECT) in severe depression with psychotic features, and sometimes are used in the management of patients with psychotic disorders associated with delirium or dementia or induced by other agents (e.g., stimulants or L-DOPA). 

In another report, a 70-year-old depressed man with no significant medical illness developed auditory and visual hallucinations after 3 days of escitalopram treatment at 5 mg per day, continuing when citalopram was increased to 10 mg per day. Investigations, including cranial MRI were negative, his MMSE score was 23/30 and there was no evidence of either delirium or dementia. Following suspicion of drug-induced psychotic symptoms, escitalopram was tapered to 5 mg per day and ceased after which his psychotic symptoms abated [36 ]. 

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. 

These types of antidepressant were introduced around 10 years after the SSRIs. They include the serotonin noradrenaline reuptake inhibitor venlafaxine and the selective noradrenaline reuptake inhibitor reboxetine. Although there are fewer data about these drugs, clinical experience has shown they are well tolerated and, unlike the SSRIs, they are only weak inhibitors of drug metabolism (Kent, 2000). Depression is a common psychiatric disorder seen in the elderly and often remains untreated or inadequately treated (Forsell and Fastbom, 2000). Venlafaxine was shown to improve the mood in a group of 36 older patients without any effect on cognitive function, an important consideration where there is the possibility of the coexistence of mild or undiagnosed dementia (Tsolaki et al., 2000). 

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