Depressive disorders antidepressants

Levitan RD, Shen J-H, Jindal R, Driver HS, Kennedy SH, Shapiro CM. Preliminary randomized double-blind placebo-conttolled trial of tryptophan ccmbined with fluoxetine to treat major depressive disorder antidepressant and hjfpnotic effects. JPsychiatry Neurosci (2000)... 

Treatment of Major Depression. Dmgs commonly used for the treatment of depressive disorders can be classified heuristicaHy iato two main categories first-generation antidepressants with the tricycHc antidepressants (TCAs) and the irreversible, nonselective monoamine—oxidase (MAO) inhibitors, and second-generation antidepressants with the atypical antidepressants, the reversible inhibitors of monoamine—oxidase A (RIMAs), and the selective serotonin reuptake inhibitors (SSRIs). Table 4 fists the available antidepressants. 

Two recently introduced antidepressants are notable m that they are selective serotonin uptake inhibitors Citalopram (19) is reported to be as effective as amitriptyline m the treatment of endogenous depression [75, 16] Fluoxetine (20) as the hydrochlonde is approved for major depressive disorders mcludmg those with concomitant anxiety Interestmgly, it also appears useful m the treatment of obesity [17]... 

The authors concluded that antidepressants exert a modest beneficial effect for patients with combined depressive disorder and substance use disorder. They also emphasized that antidepressants are not a stand-alone treatment for depressed alcoholic patients and that concurrent therapy directly targeting the substance use disorder is also indicated. 

In summary, research on the use of antidepressants to treat cannabis dependence, particularly among individuals with comorbid major depressive disorder, although limited, offers a promising avenue for the development of pharmacological aids to assist in the treatment of cannabis withdrawal. There are clear parallels between this literature and the existing research on the use of antidepressants in the treatment of alcohol dependence comorbid with major depressive disorder (see Chapter 1, Medications to Treat Co-occurring Psychiatric Symptoms or Disorders in Alcoholic Patients). 

Geddes JR, Freemantle N, Mason J, Eccles MP, Boynton J (1999). SSRIs versus alternative antidepressants in depressive disorder (Cochrane Review). In Cochrane Library, Issue 4. Oxford Update Software. 

Yu, Y. W., Tsai, S. J. etal. (2002). Association study of the serotonin transporter promoter polymorphism and symptomatology and antidepressant response in major depressive disorders. Mol. Psychiatry, 7(10), 1115-19. 

Yoshida, K. et al. (2002). Monoamine oxidase a gene polymorphism, tryptophan hydroxylase gene polymorphism and antidepressant response to fluvoxamine in Japanese patients with major depressive disorder. Prog. Neuropsychopharmacol. Biol. Psychiatry, 26, 1279-83. 

Lee, S. H., Lee, K. J., Lee, H. J. etal. (2005). Association between the 5-HT6 receptor C267T polymorphism and response to antidepressants treatment in major depressive disorder. Psychiatry Clin. Neurosci., 59, 140-5. 

Wu, W.H., Huo, S.J., Cheng, C.Y., Hong, C.J. Tsai, S.J. (2001). Association study ofthe 5-HT (6) receptor polymorphism (C267T) and symptomatology and antidepressant response in major depressive disorders. Neuropsychobiology, 44, 172-5. 

Kirchheiner, J., Bertilsson, L., Bruus, H. etal. (2003). Individualized medicine - implementation ofpharmacogenetic diagnostics in antidepressant drug treatment of major depressive disorders. Pharmacopsychiatry, 36, 235-43. 

Hansen, Richard A., Gerald Gartlehner, Kathleen N. Lohr, Bradley N. Gaynes and Timothy S. Carey, Efficacy and Safety of Second-Generation Antidepressants in the Treatment of Major Depressive Disorder , Annals of Internal Medicine 143 (2005) 415-26... 

Antidepressant A drug used principally to treat major depressive disorder (unipolar depression). 

The antidepressant effects reported for some drugs that antagonize NMDA receptors suggest a role for the glutamatergic system in depressive disorders 892... 

The efficacy of psychotherapy and antidepressants is considered to be additive. Psychotherapy alone is not recommended for the acute treatment of patients with severe and/or psychotic major depressive disorders. For uncomplicated nonchronic major depressive disorder, combined treatment may provide no unique advantage. Cognitive therapy, behavioral therapy, and interpersonal psychotherapy appear to be equal in efficacy. 

Stahl, S.M., Kaiser, L., Roeschen, J., Keppel Hesselink, J.M. and Orazem, J. (1998) Effectiveness of ipsapirone, a 5-HT-1A partial agonist, in major depressive disorder support for the role of 5-HT-1A receptors in the mechanism of action of serotonergic antidepressants. International Journal of Neuropsychopharmacology, 1, 11-18. 

Sue is 42 years old and experiencing her second episode of major depressive disorder. She has never been on antidepressants before but this time wouid iike to try medication as part of her treatment. The initiai assessment period for her wiii be a few days to a week after starting to make sure that the medication is not producing uncomfortabie side effects. After 3-4 weeks, we expect to see some improvement in her mood if there is no change whatsoever, many physicians wouid change antidepressants after 4-5 weeks. Finaiiy, when there has ceased to be any further improvement in mood, we want to know, "is she weii or is she oniy better " if the answer is that she has oniy gotten better, but not yet weii, then we have more work to do. 

Eava M, Schmidt ME, Zhang S, et al. Treatment approaches to major depressive disorder relapse. Part 2 Reinitiation of antidepressant treatment. Psychother Psychosom 2002 71(4) 195-199. 

Atypical Antidepressants. None of the so-called atypical antidepressants have been tested in the treatment of AN. However, mianserin, an antidepressant available in Europe, has been found to increase body weight in patients with various depressive disorders. Although bupropion (Wellbutrin, Zyban) has not been tested in the treatment of AN, it is effective in the treatment of BN. However, immediate-release bupropion is associated with an especially high risk for seizures in these patients and is therefore contraindicated in those with eating disorders. The seizure risk associated with sustained-release bupropion remains unclear at this time, as the doses studied have not been as high as those for immediate-release bupropion. 

Suicidaiity in chiidren and adoiescents Antidepressants increased the risk of suicidal thinking and behavior (suicidaiity) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone... 

Suicidality in children and adolescents Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of trazodone or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Trazodone not approved for use in pediatric patients (see Clinical worsening and suicide risk and Children sections in Warnings). 

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