Treatment of unipolar major depression: Algorithms for pharmacotherapy

Kasper, Siegfried; Bech, Per; Dejonghe, F; Sousa, M. Paes De; Dinan, Timothy G.; Guelfi, Julien‐Daniel; Higuchi, Tetsuya; Larsen, J. K.; Lecrubier, J P; Lerer, Bernard; Neumeister, Alexander; Papadimitriou, George; Paykel, Eugene S.; Pöldinger, W; Švestka, Jaromír; Walter, Henrik

doi:10.3109/13651509709024749

Cited by 8 publications

(4 citation statements)

References 5 publications

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“…It has been suggested that the dose should be increased if patient compliance is good and there is no response after three weeks. If there is a partial response, another two weeks could be waited before increasing the dose 17. For patients at risk of suicide, the amount of drug prescribed at one time should be limited, particularly with the older, more toxic antidepressants.…”

Section: Establishing the Optimum Dosementioning

confidence: 99%

Fortnightly review: Drug treatment of depression

Spigset

Mårtensson

1999

BMJ

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Section: Establishing the Optimum Dosementioning

confidence: 99%

Fortnightly review: Drug treatment of depression

Spigset

Mårtensson

1999

BMJ

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“…If there is no response (< 25% improvement) after 3 weeks it is possible to increase the dose, while in case of a partial response, one could wait another 2 weeks before increasing the dose. 124 …”

Section: Acute Treatmentmentioning

confidence: 99%

Treatments in depression

Duval

Lebowitz

Mâcher

2006

Dialogues in Clinical Neuroscience

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Major depression is believed to be a multifactorial disorder involving predisposing temperament and personality traits, exposure to traumatic and stressful life events, and biological susceptibility. Depression, both unipolar and bipolar, is a "phasic" disease. Stressful life events are known to trigger depressive episodes, while their influence seems to decrease over the course of the illness. This suggests that depression is associated with progressive stress response abnormalities, possibly linked to impairments of structural plasticity and cellular resilience. It therefore appears crucial to adequately treat depression in the early stages of the illness, in order to prevent morphological and functional abnormalities. While evidence suggests that a severely depressed patient needs antidepressant drug therapy and that a non-severely depressed patient may benefit from other approaches (ie, "nonbiological"), little research has been done on the effectiveness of different treatments for depression. The assertion that the clinical efficacy of antidepressants is comparable between the classes and within the classes of those medications may be true from a statistical viewpoint, but is of limited value in practice. The antidepressant drugs may produce differences in therapeutic response and tolerability. Among the possible predictors of outcome in depression treatment, those derived from clinical assessment, neuroendocrine investigations, polysomnographic sleep parameters, genetic variables, and brain imaging techniques have been extensively studied. This article also reviews therapeutic strategies used when initial treatment fails, and describes briefly new concepts in antidepressant therapies such as the regulation of disturbances in circadian rhythms. The treatment of depressive illness does not stop with treatment of acute episodes, and has to be envisaged as a continuous therapeutic intervention, of which we are still not able to determine the optimal duration of treatment and the moment that it should be ceased.

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“…In Psychiatry for Medical Students [6], disorder of thinking includes disturbed thought process (altered flow of ideas and quality of associations), disturbed rate and flow (racing thoughts, slowed thoughts, circumstantiality, blocking, perseveration), abnormal associations (loosening of associations, flight of ideas, tangentiality, clanging, punning), and other abnormalities (neologisms, word salad, echolalia).…”

Section: Multispeak In Psychiatrymentioning

confidence: 99%

Prescribing of Psychotropic Drugs in an Acute Inpatient Unit

1999

Aust N Z J Psychiatry

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Recent articles in the Australian and New Zealand Journal of Psychiatry [1,2] have discussed changes in the prescribing of antidepressant and antipsychotic drugs. Beerworth and Tiller [1] noted the medicolegal advantages of initiating pharmacological therapy for depression with newer antidepressants, such as selective serotonin re-uptake inhibitors (SSRIs), selective serotonin/noradrenaline re-uptake inhibitors (SNRIs), reversible inhibitors of monoamine oxidase A (RIMAs) and 5HT 2 receptor antagonists, rather than older antidepressants such as the tricyclics. Parker et al.[2] investigated changes in the use of antipsychotic drugs, reporting that 33% of a sample of psychiatrists surveyed in 1996 advocated the use of an atypical antipsychotic agent (risperidone) in preference to conventional antipsychotics in the treatment of first-episode psychosis. Parker et al.[2] also noted that the antipsychotic drug doses favoured by their sample of psychiatrists were about half those recommended by the Quality Assurance Project in 1984. Recently published treatment algorithms for depression and schizophrenia [3-7] vary in their recommendations regarding the place of the newer agents in the clinical pathway. This may reflect differences in the methods used to derive the algorithms, but also indicates a lack of consensus in defining best practice.There has been little information published recently about the actual use of novel antipsychotic and antidepressant drugs in psychiatric practice in Australia. Such information would be helpful in gauging the extent to which the newer treatments have been adopted.This letter reports on the medication prescribed on one day (13 August 1998) at Cramond Clinic, a 40bed acute psychiatric inpatient unit serving the Western suburbs of Adelaide. Thirty-five medication sheets were available. The remaining patients were in the process of admission or discharge, or not on the ward.Sixty-one percent (n = 17) of the 28 patients receiving antipsychotic medication were prescribed the atypical drugs olanzapine (n = 14) or risperidone (n = 3). The mean daily dose of olanzapine was 14 mg, and of risperidone was 1 mg. Typical antipsy-

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Treatment of unipolar major depression: Algorithms for pharmacotherapy

Cited by 8 publications

References 5 publications

Fortnightly review: Drug treatment of depression

Fortnightly review: Drug treatment of depression

Treatments in depression

Prescribing of Psychotropic Drugs in an Acute Inpatient Unit

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