Psychotropic agents antidepressants

This behavioural syndrome, rather emotively called learned helplessness", is widely believed to share many features of depression, not least because both culminate in psychomotor retardation and both are linked with experience of uncontrollable, unpredictable stress. Whether or not learned helplessness really is an analogue of depression remains controversial (Maier 1993). Nevertheless, escape deficits in rats are prevented by pretreatment with antidepressants from different generic groups. Other psychotropic agents, such as CNS stimulants and neuroleptics, are generally ineffective. 

Most of the research and results have been focused on the effects of drug therapy on the disorders induced by alcohol, and by opiates abuse. For all drugs, the first objective is to wean the patients from the drug, treating or preventing the effects of withdrawal for those drugs which cause physical dependence (alcohol, nicotine, opiates, caffeine, certain psychotropic agents such as benzodiazepines, possibly antidepressants). The second phase is the prevention of recurrence or relapse, which relies on a com-... 

Gastric acidity will also affect the absorption of medication. An acidic environment increases the absorption of weak acids, whereas the absorption of weak bases is facilitated by a less acidic environment. Many psychotropic agents such as tricyclic antidepressants (TCAs] and benzodiazepines are weak bases. Older studies of gastric acid secretion found that women have approximately 33%-40% lower basal gastric acid secretion than do men [Yonkers and Hamilton 1995]. Gastric acid secretion may be further decreased in the luteal phase of the menstrual cycle (Booth et al. 1957]. 

Lambert 1984 McElroy et al. 1988b] suggested that valproate may be a much better antimanic than antidepressant agent. In a study of 78 consecutively recruited patients with rapid-cycling bipolar disorder treated with open-label valproate alone or in combination with other psychotropic agents, Calabrese and colleagues [Calabrese and Delucchi 1990 Calabrese et al. 1992] reported a 54% valproate response in acute mania, an 87% response in acute mixed states, and a 19% response in acute depression. However, they did observe a prophylactic antidepressant effect in patients subsequently. Additional controlled studies are needed to clarify valproate s antidepressant efficacy. 

Conversely, many patients have psychiatric conditions that require the concomitant use of several psychotropic agents. The carefully considered, rational use of several psychiatric medications must be distinguished from ill-considered polypharmacy. An example of useful combined treatment is the addition of lithium to antidepressant therapy in the case of a patient who has achieved only a partial response to treatment with an antidepressant alone. 

Uremia Antihistamines Antiparkinsonian agents Antispasmodics Ophthalmic preparations OTC sleep/allergy medications Tricyclic antidepressants Other medications Analgesics/NS AIDs Anticonvulsants Corticosteroids (high dose) Digoxin H2 blockers Insulin Muscle relaxants Narcotics Psychotropics (anxiolytic, antidepressant, antipsychotic) Sedative/hypnotic Sulfonylurea... 

Hence, minor structural changes in the imipramine, amitriptyline, and promazine group of psychotropic agents can bring about very marked alterations in the psychopharmacologic properties of the derivative compounds which have endowed these compounds with a greater selectivity of antidepressant action and, in some instances, shortened the latent period of onset. 

Dibenzosuberone, 10,ll-dihydro-5//-dibenzo[a,tf]cycloheptene-5-one, is an important intermediate in the preparation of psychotropic agents, e. g. the antidepressants amitiptyline and nortiptyline, and other drugs, and was made by an internal double Heck coupling in which the dibenzodibromo derivative gave, in the presence of Pd/C, the corresponding dibenzocycloheptane-ejfo-acrylate derivative (Scheme 11) [31b]. 

Treatment discontinuation of several psychotropic agents has been proposed to increase the risk of recurrence of morbidity to a degree greater than would be predicted by the natural history of untreated illness this risk probably extends over several months. Evidence for this phenomenon is particularly strong with lithium in bipolar disorder, is likely with some antipsychotics, and may occur with antidepressants. Such risk may be reduced by gradual discontinuation of long-term medication over at least several weeks see Chapter 18). 

Montejo, A.L., Llorca, G., Izquierdo, J.A., and Rico-Villademoros, F. (2001) Incidence of sexual dysfunction associated with antidepressant agents a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. / Clin Psychiatry 62 10-21. 

Important biological differences that potentially affect the metabolism of psychotropics have been described between Japanese and non-Asian children. For example, a pharmacogenetic ethnic difference was reported in cytochrome P450 (CYP) 2D6 metabolism of several antipsychotics and antidepressants, and in the CYP 2C19 metabolism of tricyclic agents. In adults, the rate of poor metabolizers of CYP 2D6 substrates is lower in Asians (about 1%) than in Caucasians (about 7%), while that of CYP 2C19 substrates is higher in Asians (15%-30%) than in Caucasians (3%-6%) (Poolsup et ah, 2000). Clinicians may need to keep these differences in mind when they use psychotropics in Japanese and other Asian patients, since such differences can lead to different behavioral responses or toxicity. 

The first psychotropics of the modern era (e.g., lithium, neuroleptic antipsychotics, tricyclic and monoamine oxidase inhibitor antidepressants) were discovered serendipitously. These agents were not engineered to have selective actions, but instead produce a wide range of central biochemical effects and generally affect more than one neurotransmitter system simultaneously, resulting in multiple repercussions ... 

A related issue is that many psychotropics are known to lower the seizure threshold. Therefore increased care is warranted when these agents are used in conjunction with TMS. However, Turnier-Shea and colleagues (213) reviewed their experience with 82 patients on various medication combinations who also received a total of 986 TMS treatments. There were no seizures reported, and the authors suggest that the concomitant use of some antidepressants and TMS should not be prohibited. Here, SF-rTMS may be preferable to HF-rTMS given that most reports of seizures involved the latter approach and because SF-rTMS may induce neuronal inhibition rather than excitation (191, 205). Imaging and EEG data in combination with clinical studies should provide more information about the effectiveness and safety of different frequencies. 

Antidepressants are commonly prescribed with other psychotropic and nonpsychotropic agents. There is potential for drug interactions with all antidepressants, but the most serious of these involve the MAOIs and to a lesser extent the TCAs. 

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