Depression
Henry J. Woodford in Essential Geriatrics, 2022
The majority of antidepressants are believed to act by potentiating the effects of serotonin and/or norepinephrine within the brain. There is insufficient evidence to reliably compare all of the available antidepressant medications with one another. Meta-analyses suggest that the differences in efficacy and adverse events between serotonin specific reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs) and atypical agents may only be small.24 However, a review of studies performed in primary care suggested that SSRIs are better tolerated than TCAs.25 The decision on which agent to choose may be based on adverse effect profiles (seeTable 8.1). Those with more anticholinergic properties (e.g. TCAs; see page 47) are usually best avoided in older people. Another factor is whether it would be beneficial to stimulate or sedate the patient, depending on presenting symptoms. Those with insomnia may benefit from a sedating drug such as mirtazapine at night, whereas those with lethargy or withdrawal may be more suited to a non-sedating drug such as sertraline.
Examples from Actual Clinical Trials in Choosing and Specifying Estimands
Craig Mallinckrodt, Geert Molenberghs, Ilya Lipkovich, Bohdana Ratitch in Estimands, Estimators and Sensitivity Analysis in Clinical Trials, 2019
MDD is a common psychiatric condition with a lifetime incidence of approximately 15% (Kessler et al., 2005). The disorder ranges from mild to severe and is associated with significant potential morbidity and mortality, contributing to suicide and adverse impact on concomitant medical illnesses, interpersonal relationships, and work. The objectives of treatment are to reduce or resolve signs and symptoms of the disease, restore psychosocial and occupational function, and reduce the likelihood of relapse or recurrence (Primary Care Clinical Practice Guideline, 2010). Guidelines support pharmacological therapy for the treatment of depression in addition to psychotherapy. Antidepressant medications include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, serotonin-dopamine activity modulators (SDAMs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) (Practice Guideline for The Treatment of Patients With Major Depressive Disorder, 2010).
Formulary
Quentin Spender, Niki Salt, Judith Dawkins, Tony Kendrick, Peter Hill, David Hall, Jackie Carnell in Child Mental Health in Primary Care, 2018
There is a wide choice of antidepressants available. There is such a high risk of overdose in adolescents that treatment with full doses of tricyclic antidepressants is no longer justified, particularly since a controlled trial of fluoxetine in adolescents was published,4 making selective serotonin reuptake inhibitors39.3 the first-choice treatment. With the exception of citalopram, for which fatal overdose has been reported,5 the selective serotonin reuptake inhibitors are safe in overdose. Related antidepressants with a slightly different range of receptor selectivity can also be useful, and are also safe in overdose. We mention our own selection here. For instance, we have found that paroxetine seems to be over-stimulating in children (although not in adults), and therefore we do not recommend this drug. A single daily dosage, and a dosage regime that requires no adjustment, both improve compliance.
Pilot Study: The Effects of a Mountain Wilderness Experience on Combat Veteran Psychosocial Wellness
Published in Military Behavioral Health, 2023
Elizabeth J. Vella, Taylor Lyman, Taylor Lovering
Current PTSD treatments focus on symptom management and include exposure therapy, cognitive behavioral therapy (CBT), and pharmacotherapy. Due to the comorbid nature of PTSD with anxiety and depression, antidepressants are one of the most common drugs administered for pharmacologic treatment (National Institutes of Mental Health, 2020). Although the efficacy of the current treatment therapies for PTSD are widely supported in literature, a considerable amount of patients may remain symptomatic despite treatment efforts (e.g., Kitchiner et al., 2019), thereby suggesting a need to explore complementary therapies. The goal of more holistic approaches to treating veterans with PTSD is not only to assist in symptom management and enhancement of quality of life, but also to help veterans develop healthy lifestyle behaviors; these behaviors may include recreational activities, establishment of social support networks, and increased ability to cope with stress (Charney & Marx, 2012). Recent literature has demonstrated substantial support for outdoor environmental leisure programs producing positive impacts on veterans with PTSD, both in terms of symptom management, improved mood, and reductions in anxiety, depression, and stress (Bettmann et al., 2021; Greer & Vin-Raviv, 2019; Walker et al., 2020).
SSRI withdrawal syndrome in children and adolescents: a narrative literature review
Published in Expert Opinion on Drug Safety, 2023
Yasser Saeed Khan, Mohamed Adil Shah Khoodoruth, Yahia Albobali, Peter M. Haddad
The terms ‘Discontinuation’ and ‘Withdrawal’ have been used historically to describe the symptoms experienced by patients when antidepressant medication are stopped abruptly but both have invited criticism. Rather than getting bogged down in semantics, we would argue that irrespective of the term used, it is important to inform patients, whether adults or young people, about the nature of these symptoms before they start antidepressant treatment. This includes informing patients that antidepressant withdrawal symptoms occur on a spectrum of severity. At the severe end of the spectrum, symptoms can cause functional impairment and make it very difficult or impossible for a person to stop taking antidepressants, even when they are tapered slowly. At the other end of the spectrum are patients who can stop antidepressants abruptly and experience none or only mild and short-lived symptoms. There is a lack of research on the prevalence of withdrawal symptoms of different severities. It is equally important to explain to patients that antidepressants are not usually regarded as ‘addictive’ as despite causing withdrawal effects, they do not usually cause craving, tolerance, and loss of control over use which are features seen with most drugs traditionally regarded as addictive, e.g. alcohol, nicotine, and opiates.
Therapeutic potential of plant iridoids in depression: a review
Published in Pharmaceutical Biology, 2022
Yaoyao Kou, Zhihao Li, Tong Yang, Xue Shen, Xin Wang, Haopeng Li, Kun Zhou, Luyao Li, Zhaodi Xia, Xiaohui Zheng, Ye Zhao
Medications are the major treatment for depression. There are five main classes of antidepressants commonly used today: selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and atypical antidepressants (Skånland and Cieślar-Pobuda 2019). Outpatient-related reports state that only 25% of patients are in remission within 6 months and over 50% of patients are still depressed after 2 years. The chance of relapse is high, with approximately 80% of patients relapsing at least once in their lifetime (Wells et al. 1992; Penninx et al. 2011). In addition, these medications have a variety of negative effects, such as nausea, dizziness, headaches, and gastrointestinal discomfort, which can also lead to weight gain, sexual dysfunction, and sleep disorders (Cassano and Fava 2004; Cipriani et al. 2018). As a result, pharmaceutical practitioners pay attention to the screening and discovery of beneficial ingredients from natural products for the treatment of depression with few side effects.
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