| Antidepressants are used commonly in
| |
| | and clonazepam).OCD has been shown to
|
| medical and psychiatric practice. As a
| |
| | respond to the serotonin-selective
|
| class, antidepressants have in common
| |
| | tricyclic clomipramine (Anafranil) and to
|
| their ability to treat major depressive
| |
| | SSRIs at high doses (e.g., fluoxetine at
|
| illness. Most antidepressants are also
| |
| | 60-80mg/ day). Obsessions tend to be more
|
| effective in the treatment of panic
| |
| | responsive to pharmacotherapy than
|
| disorder and other anxiety disorders.
| |
| | compulsions. Symptoms of OCD respond more
|
| Some antidepressants effectively treat
| |
| | slowly than symptoms of major depression.
|
| obsessive-compulsive disorder (OCD) and a
| |
| | Trials of 12 weeks or more are needed
|
| variety of other conditions (see
| |
| | before a medication can be ruled a
|
| indications below).The most commonly
| |
| | failure for an OCD patient.The binging
|
| prescribed antidepressants are listed in
| |
| | and purging behavior of bulimia has been
|
| Table 12-1. Antidepressants are
| |
| | shown to respond to SSRls, TCAs, and
|
| subdivided into groups based on structure
| |
| | MAOls in several open and controlled
|
| or prominent functional activity:
| |
| | trials. Because SSRIs have the most
|
| selective serotonin reuptake inhibitors
| |
| | benign side-effect profile of these
|
| (SSRls), tricyclic antidepressants
| |
| | medications, they are often the
|
| (TCAs), monoamine oxidase inhibitors
| |
| | first-line psychopharmacologic
|
| (MAOls), and other antidepressant
| |
| | treatment.Mechanisms of
|
| compounds with a variety of mechanisms of
| |
| | ActionAntidepressants are thought to
|
| action. Antidepressants are typically
| |
| | exert their effects at particular subsets
|
| thought to act on either the serotonin or
| |
| | of neuronal synapses throughout the
|
| norepinephrine systems, or both. Choice
| |
| | brain. Their major interaction is with
|
| of medications typically depends on
| |
| | the monoamine neurotransmitter systems
|
| diagnosis, history of response (in
| |
| | (dopamine, norepinephrine, and
|
| patient or relative), and the side-effect
| |
| | serotonin). Dopamine, norepinephrine, and
|
| profile of the medication. Antidepressant
| |
| | serotonin are released throughout the
|
| effects are typically not seen until 2 to
| |
| | brain by neurons that originate in the
|
| 4 weeks into treatment. Side effects must
| |
| | ventral brainstem, locus ceruleus and the
|
| be carefully monitored, especially for
| |
| | raphe nuclei, respectively. These
|
| TCAs and MAOls.IndicationsTable 12-2
| |
| | neurotransmitters interact with numerous
|
| lists the indications for
| |
| | receptor subtypes in the brain that are
|
| antidepressants.
| |
| | associated with the regulation of global
|
| The main indication for antidepressant
| |
| | state functions including appetite, mood
|
| medications is major depressive disorder
| |
| | states, arousal, vigilance, attention,
|
| as defined by the Diagnostic and
| |
| | and sensory processing.SSRls act by
|
| Statistical Manual of Mental Disorders,
| |
| | binding to presynaptic serotonin reuptake
|
| 4th edition (DSM-IV). Antidepressants are
| |
| | proteins, thereby inhibiting reuptake and
|
| used in the treatment of all subtypes of
| |
| | increasing the levels of serotonin in the
|
| depression, including depressed phase of
| |
| | synaptic cleft.TCAs act by blocking
|
| bipolar disorder, psychotic depression
| |
| | presynaptic reuptake of both serotonin
|
| (in combination with an antipsychotic
| |
| | and norepinephrine. MAOls act by
|
| medication), atypical depression, and
| |
| | inhibiting the presynaptic enzyme
|
| seasonal depression. Antidepressants also
| |
| | (monoamine oxidase) that catabolizes
|
| are indicated for the prevention of
| |
| | norepinephrine, dopamine, and serotonin,
|
| recurrent depressive
| |
| | thereby increasing the levels of these
|
| episodes.Antidepressant medications may
| |
| | neurotransmitters presynaptically.These
|
| be effective in the treatment of patients
| |
| | immediate mechanisms of action are not
|
| with dysthymic disorder, especially when
| |
| | sufficient to explain the delayed
|
| there are clear neurovegetative signs or
| |
| | antidepressant effects (typically 2 to 4
|
| a history of response to
| |
| | weeks). Other unknown mechanisms must
|
| antidepressants.Panic disorder with or
| |
| | play a role in the successful
|
| without agoraphobia has been shown to
| |
| | psychopharmacologic treatment of
|
| respond to SSRls, MAOls, TCAs, and
| |
| | depression.
|
| high-potency benzodiazepines (alprazolam
| |
| |
|
