Natural Prozac: Learning to Release Your Body's Own Anti-Depressants. Joel C. Robertson and Tom Monte. 215 pp. HarperCollins Publishers, Inc., New York; HarperCollins Canada Ltd., Toronto. 1997. ISBN 0-06-251353-2 Strengths: Clearly written and easy to understand. Weaknesses: Downplays the role of medication in the treatment of depression, which may lead patients to delay seeking medical help or to discontinue treatment prematurely; some of the program plans are not substantiated. Audience: Patients with mild symptoms of depression or ... Read More

Depression sufficient to warrant professional care affects 2% to 4% of the general population. Cassem has observed that "92% of all persons suffering from it are either treated by nonpsychiatric personnel or are not treated at all". Tricyclic antidepressants constitute the major form of treatment of depression. They are also used to treat various other conditions, such as phobias, obsessive-compulsive disorders, enuresis, sleep disorders (e.g., narcolepsy) and depressive equivalents (e.g., ... Read More

Speaking of sadness. Depression, disconnection, and the meanings of illness David A. Karp Oxford University Press Canada, 1996, 240 pp Strengths Excellent description of isolation and disconnection of sufferers. Excellent bibliography. Weaknesses Philosophical discussion might not interest everyone. Pharmacologic treatment and its outcomes need more discussion from patients' perspective Audience Chronically depressed people, medical students, family practice residents, family physicians, and specialists Depression is a terrifying illness and ... Read More

Over the years, most of the research into the pharmacotherapy of major depression has focused on the treatment of the acute depressive episode. There is a vast literature which documents the efficacy of the tricyclic antidepressants, monoamine oxidase inhibitors and, more recently, the serotonin reuptake inhibitors in the acute management of unipolar major depressive disorder. Recently however, there has been an effort to define ... Read More

Cardiovascular In the current Zoloft labeling, it is noted that analysis of ECG data from 774 patients receiving sertraline in clinical trials revealed no pattern of significant ECG abnormalities. In this database, cardiovascular adverse experiences were not important causes of discontinuation from treatment and were not among the common, drug related adverse events. A slight decrease in mean heart rate was observed, as noted above. No serious adverse events involved the cardiovascular ... Read More

Current concepts of classification The classification of depression is a broad topic, sufficient to keep armies of psychiatrists disputing happily for years. This paper will focus particularly on the concept of anxious depression, and its relevance to other classifications. I will not deal directly with the distinction between anxiety and depression, which is covered elsewhere in this session. I am more concerned with the place of anxiety in the classification of ... Read More

Concomitant administration of imipramine, lithium, and levomepromazine had no effect on Tmax values of citalopram or its metabolites. In contrast, cimetidine caused a statistically significant decrease in the Tmax value of citalopram and an increase in that of DCT. In an evaluation of the effects of psychotropic drugs on serum citalopram concentrations in psychiatric patients, individual neuroleptics (perphenazine, thioridazine, periciazin, chlorpromazine, haloperidol, zuclopenthixol, and levomepromazine) had no effect on serum citalopram ... Read More

Directions for use conveyed in the sponsor's proposed labeling are as follows: Citalopram should be administered at a dose of 20 mg once daily. Clinical trials demonstrating antidepressant effectiveness studied the recommended therapeutic dose range of 20-60 mg/day. Patients not responding to 20 mg may benefit from dose increases, in 20 mg/day increments, up to a maximum of 60 mg/day. Dose changes should occur at intervals of at least one week. Citalopram ... Read More

There are three levels of symptoms to watch for: somatic symptoms, strategies to relieve discomfort, and social withdrawal. Somatic Symptoms The primary somatic symptom of early depression is insomnia. Soon afterwards loss of energy, easy fatigability and lack of staying power are reported. Vague gastrointestinal complaints are commonplace — anorexia with upper gastric pain not necessarily meal-related, loose stools, gas, etc. The patient's record may indicate several ... Read More

AE - Adverse Event CRF - Case Report Form DCT - Demethylcitalopram DDCT - Didemethyl Metabolite DSU - Drug Surveillance Unit ECG - Electrocardiogram ISS - Integrated Summary of Safety PMDD - Premenstrual Dysphoric Disorder PMS - Premenstrual Syndrome SAE - Serious Adverse Event SIADH - Syndrome of Inappropriate Antidiuretic Hormone SSRI - Selective Serotonin Reuptake Inhibitor TAD - Tricyclic Antidepressant TEAE - Treatment-emergent Adverse Event ... Read More