Depressive disorders 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... 

A normal response is an increase in plasma TSH of 5 to 15 pU/mL above baseline. A response of less than 5 pU/mL above baseline is generally considered to be blunted (some laboratories consider a response below 7 pU/mL to be blunted) and may be consistent with a major depression. An abnormal test is found in approximately 25% of patients with depression. A blunted TSH response (especially in conjunction with an abnormal DST) may help in confirming the differential diagnosis of a major depressive episode and support continued antidepressant treatment. An increased baseline TSH or an augmented TSH response (higher than 30 pU/mL), in conjunction with other thyroid indices, might identify patients with hypothyroidism, mimicking a depressive disorder. These patients may benefit most from thyroid replacement therapy. 

Furthermore, most psychiatric disorders are chronic, although some may go through intervals of apparent remission (e.g., major depressive disorder), whereas others are persistent but relatively asymptomatic (e.g., schizophrenia) with effective treatment. Flence, treatment with psychotropics is best considered in terms of months or years of continuous or intermittent therapy, rather than a few days or weeks. By contrast, the vast majority of the clinical trials involve short-term use. Thus, a typical database for the approval of a new antidepressant is usually based on experience with 2,000 to 8,000 patients (carefully selected as described earlier), with the majority exposed to the medication for less than 2 months. Often less than 25% will have received medication for more than 4 months, and less than 10% for more than 6 months. When a drug is marketed, most patients will be exposed to it for a minimum of 4 to 6 months. Yet, when treatment goes beyond 2 months, the database on the safety and continued efficacy of a medication is modest at best. Thus, although clinicians commonly use psychotropics for both maintenance and prophylactic purposes, an approved drug only has to be shown effective in the acute phase. 

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

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. 

Allopurinol (4-hydroxypyrazolo [3, 4-d] pyrimidine) is an inhibitor of xanthine oxidase that was successfully introduced in the treatment of primary gout about 45 years ago [171]. Allopurinol continues to be accepted as standard therapy in the treatment of primary and secondary hyperuricemia. Adverse reactions occur in about 10% of patients treated with allopurinol and are relatively mild and self-limited [171,172]. A mild maculopapular eruption or gastrointestinal disorders are usually noted, which promptly regress with cessation of therapy. Isolated instances of allopecia [173], bone marrow depression [174], ocular lesions [175], acute cholangitis [176], various types of hepatic injuries [177,178] temporal arthritis [179], and xanthine stones [180] have been reported. Recently, LaRosa et al [180a] have reported a case of xanthine nephropathy during treatment of childhood T-cell ALL. 

Anxiety disorders are chronic conditions and drug therapy may need to continue for months or even years, particularly for the more intractable disorders such as (XD and PTSD. Response rates are often incomplete, and relapse upon discontinuation of treatment is common. For disorders with multiple symptoms (e.g., PTSD) only some of the symptoms are relieved. Coexistence of anxiety with other mental disorders, particularly depression (18,19), is very common and such comorbidity is predictive of a poorer treatment outcome. 

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