Antidepressants and Phototherapy
Marcello Lanares asked:
Antidepressants are used commonly in medical and psychiatric practice. As a class, antidepressants have in common their ability to treat major depressive illness. Most antidepressants are also effective in the treatment of panic disorder and other anxiety disorders. Some antidepressants effectively treat obsessive-compulsive disorder (OCD) and a variety of other conditions (see indications below).
The most commonly prescribed antidepressants are listed in Table 12-1. Antidepressants are subdivided into groups based on structure or prominent functional activity: selective serotonin reuptake inhibitors (SSRls), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOls), and other antidepressant compounds with a variety of mechanisms of action. Antidepressants are typically thought to act on either the serotonin or norepinephrine systems, or both. Choice of medications typically depends on diagnosis, history of response (in patient or relative), and the side-effect profile of the medication. Antidepressant effects are typically not seen until 2 to 4 weeks into treatment. Side effects must be carefully monitored, especially for TCAs and MAOls.
Indications
Table 12-2 lists the indications for antidepressants.
The main indication for antidepressant medications is major depressive disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Antidepressants are used in the treatment of all subtypes of depression, including depressed phase of bipolar disorder, psychotic depression (in combination with an antipsychotic medication), atypical depression, and seasonal depression. Antidepressants also are indicated for the prevention of recurrent depressive episodes.
Antidepressant medications may be effective in the treatment of patients with dysthymic disorder, especially when there are clear neurovegetative signs or a history of response to antidepressants.
Panic disorder with or without agoraphobia has been shown to respond to SSRls, MAOls, TCAs, and high-potency benzodiazepines (alprazolam and clonazepam).
OCD has been shown to respond to the serotonin-selective tricyclic clomipramine (Anafranil) and to SSRIs at high doses (e.g., fluoxetine at 60-80mg/ day). Obsessions tend to be more responsive to pharmacotherapy than compulsions. Symptoms of OCD respond more slowly than symptoms of major depression. Trials of 12 weeks or more are needed before a medication can be ruled a failure for an OCD patient.
The binging and purging behavior of bulimia has been shown to respond to SSRls, TCAs, and MAOls in several open and controlled trials. Because SSRIs have the most benign side-effect profile of these medications, they are often the first-line psychopharmacologic treatment.
Mechanisms of Action
Antidepressants are thought to exert their effects at particular subsets of neuronal synapses throughout the brain. Their major interaction is with the monoamine neurotransmitter systems (dopamine, norepinephrine, and serotonin). Dopamine, norepinephrine, and serotonin are released throughout the brain by neurons that originate in the ventral brainstem, locus ceruleus and the raphe nuclei, respectively. These neurotransmitters interact with numerous receptor subtypes in the brain that are associated with the regulation of global state functions including appetite, mood states, arousal, vigilance, attention, and sensory processing.
SSRls act by binding to presynaptic serotonin reuptake proteins, thereby inhibiting reuptake and increasing the levels of serotonin in the synaptic cleft.
TCAs act by blocking presynaptic reuptake of both serotonin and norepinephrine. MAOls act by inhibiting the presynaptic enzyme (monoamine oxidase) that catabolizes norepinephrine, dopamine, and serotonin, thereby increasing the levels of these neurotransmitters presynaptically.
These immediate mechanisms of action are not sufficient to explain the delayed antidepressant effects (typically 2 to 4 weeks). Other unknown mechanisms must play a role in the successful psychopharmacologic treatment of depression.
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Antidepressants are used commonly in medical and psychiatric practice. As a class, antidepressants have in common their ability to treat major depressive illness. Most antidepressants are also effective in the treatment of panic disorder and other anxiety disorders. Some antidepressants effectively treat obsessive-compulsive disorder (OCD) and a variety of other conditions (see indications below).
The most commonly prescribed antidepressants are listed in Table 12-1. Antidepressants are subdivided into groups based on structure or prominent functional activity: selective serotonin reuptake inhibitors (SSRls), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOls), and other antidepressant compounds with a variety of mechanisms of action. Antidepressants are typically thought to act on either the serotonin or norepinephrine systems, or both. Choice of medications typically depends on diagnosis, history of response (in patient or relative), and the side-effect profile of the medication. Antidepressant effects are typically not seen until 2 to 4 weeks into treatment. Side effects must be carefully monitored, especially for TCAs and MAOls.
Indications
Table 12-2 lists the indications for antidepressants.
The main indication for antidepressant medications is major depressive disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Antidepressants are used in the treatment of all subtypes of depression, including depressed phase of bipolar disorder, psychotic depression (in combination with an antipsychotic medication), atypical depression, and seasonal depression. Antidepressants also are indicated for the prevention of recurrent depressive episodes.
Antidepressant medications may be effective in the treatment of patients with dysthymic disorder, especially when there are clear neurovegetative signs or a history of response to antidepressants.
Panic disorder with or without agoraphobia has been shown to respond to SSRls, MAOls, TCAs, and high-potency benzodiazepines (alprazolam and clonazepam).
OCD has been shown to respond to the serotonin-selective tricyclic clomipramine (Anafranil) and to SSRIs at high doses (e.g., fluoxetine at 60-80mg/ day). Obsessions tend to be more responsive to pharmacotherapy than compulsions. Symptoms of OCD respond more slowly than symptoms of major depression. Trials of 12 weeks or more are needed before a medication can be ruled a failure for an OCD patient.
The binging and purging behavior of bulimia has been shown to respond to SSRls, TCAs, and MAOls in several open and controlled trials. Because SSRIs have the most benign side-effect profile of these medications, they are often the first-line psychopharmacologic treatment.
Mechanisms of Action
Antidepressants are thought to exert their effects at particular subsets of neuronal synapses throughout the brain. Their major interaction is with the monoamine neurotransmitter systems (dopamine, norepinephrine, and serotonin). Dopamine, norepinephrine, and serotonin are released throughout the brain by neurons that originate in the ventral brainstem, locus ceruleus and the raphe nuclei, respectively. These neurotransmitters interact with numerous receptor subtypes in the brain that are associated with the regulation of global state functions including appetite, mood states, arousal, vigilance, attention, and sensory processing.
SSRls act by binding to presynaptic serotonin reuptake proteins, thereby inhibiting reuptake and increasing the levels of serotonin in the synaptic cleft.
TCAs act by blocking presynaptic reuptake of both serotonin and norepinephrine. MAOls act by inhibiting the presynaptic enzyme (monoamine oxidase) that catabolizes norepinephrine, dopamine, and serotonin, thereby increasing the levels of these neurotransmitters presynaptically.
These immediate mechanisms of action are not sufficient to explain the delayed antidepressant effects (typically 2 to 4 weeks). Other unknown mechanisms must play a role in the successful psychopharmacologic treatment of depression.
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Tags: Depressed Phase, Psychiatric Practice
Types of Antidepressants
Pattrick Jhonson asked:
Antidepressants are basically a class of medicines for the treatment of depression. They generally changes the composition of neurotransmitters in the brain.
Antidepressants can be classified on the basis of how they affect the chemicals presents in our body, which are the main cause of depression. On the basis of these chemicals, the antidepressants can be classified in the following classes:
Selective Serotonin Reuptake Inhibitors (SSRIs): One of the main causes of depression is the reduction of the serotonin, which are consumed by presynaptic neuron. Serotonin is used by brain to send the signals to neurons. SSRIs prevent the consumption of serotonin, and thus maintain high level of serotonin. SSRIs include fluoxetine, paroxetine, escitalopram, citalopram and sertraline. Herbal Remedy increases its production in the body and thus reduces depression.
Monoamine Oxidase Inhibitor (MOI): MOIs reduce the depression by blocking the monoamine oxidase enzyme. MOIs are effective in the treatment of depression they have some serious side effects. The individuals taking MOIs have to be careful with their diet and avoid the intake of alcohol.
Augmenter drugs: These drugs are the combinations of one or more drugs such as tryptophan, buspirone and tranquillizers, sedatives. Tranquillizers and sedatives are helpful in curing anxiety, but they are addictive. Therefore, they are rarely used.
Newer mechanisms: There are five antidepressants, which can not be included in any of the above categories. These antidepressants are as follows:
Bupropion: It is used in the treatment of severe and seasonal depressions. It should not be used in case of epilepsy and eating disorders. It should not be prescribed to individuals less than 24 years of age as it increases the suicidal attempts.
Nefazodone: It is helpful in curing depression, but is harmful for the liver. The continued use of nefazodone can lead to liver transplant or even death in some cases.
Venlafaxine: It is used in the treatment of anxiety disorders, panic disorder and clinical depression. However, it also has side effects, which includes the attempt to suicide by the individual.
Mirtazapine: It is used in the treatment of moderate as well as severe depression. The side effects of mirtazapine is drowsiness and weight gain. It is safe even if it is overdosed.
Trazodone: It is used in the treatment of anxiety depression. It can also be used in panic and eating disorders. It should not be prescribed to children below 18 years of age as it can lead to suicidal attempts.
Butalbital Blog
Antidepressants are basically a class of medicines for the treatment of depression. They generally changes the composition of neurotransmitters in the brain.
Antidepressants can be classified on the basis of how they affect the chemicals presents in our body, which are the main cause of depression. On the basis of these chemicals, the antidepressants can be classified in the following classes:
Selective Serotonin Reuptake Inhibitors (SSRIs): One of the main causes of depression is the reduction of the serotonin, which are consumed by presynaptic neuron. Serotonin is used by brain to send the signals to neurons. SSRIs prevent the consumption of serotonin, and thus maintain high level of serotonin. SSRIs include fluoxetine, paroxetine, escitalopram, citalopram and sertraline. Herbal Remedy increases its production in the body and thus reduces depression.
Monoamine Oxidase Inhibitor (MOI): MOIs reduce the depression by blocking the monoamine oxidase enzyme. MOIs are effective in the treatment of depression they have some serious side effects. The individuals taking MOIs have to be careful with their diet and avoid the intake of alcohol.
Augmenter drugs: These drugs are the combinations of one or more drugs such as tryptophan, buspirone and tranquillizers, sedatives. Tranquillizers and sedatives are helpful in curing anxiety, but they are addictive. Therefore, they are rarely used.
Newer mechanisms: There are five antidepressants, which can not be included in any of the above categories. These antidepressants are as follows:
Bupropion: It is used in the treatment of severe and seasonal depressions. It should not be used in case of epilepsy and eating disorders. It should not be prescribed to individuals less than 24 years of age as it increases the suicidal attempts.
Nefazodone: It is helpful in curing depression, but is harmful for the liver. The continued use of nefazodone can lead to liver transplant or even death in some cases.
Venlafaxine: It is used in the treatment of anxiety disorders, panic disorder and clinical depression. However, it also has side effects, which includes the attempt to suicide by the individual.
Mirtazapine: It is used in the treatment of moderate as well as severe depression. The side effects of mirtazapine is drowsiness and weight gain. It is safe even if it is overdosed.
Trazodone: It is used in the treatment of anxiety depression. It can also be used in panic and eating disorders. It should not be prescribed to children below 18 years of age as it can lead to suicidal attempts.
Butalbital Blog
