Archives for Management
Management of Resistant Depression. Prophylaxis. Conclusion
Posted By Kelly On Wednesday, March 10th 2010 under: Management Tags: Antidepressants, Depression, Treatment
Prophylaxis
Discussing prevention of relapse or recurrence of major depression is beyond the scope of this paper but is clearly important. Long-term use of antidepressants is sometimes necessary particularly if patients have two or more episodes. Compliance becomes absolutely necessary, but side effects often cause patients to stop taking medications. Tricyclics and, to a lesser degree, traditional monoamine oxidase inhibitors (MAOIs) have many side effects because they act on the muscarinic, ... Read More
Management of Resistant Depression. Less Approaches. Treatment Resistance.
Posted By Kelly On Monday, March 8th 2010 under: Management Tags: Antidepressants, Depression, Treatment
Less common approaches.
Many less commonly used antidepressant therapies are supported by anecdotal evidence only. They include light therapy (non-seasonal affective disorder), high-dose TCA or MAOI therapy (only if serum levels can be monitored), intravenous clomipramine or maprotiline (allows for rapid perfusion, avoids first pass liver metabolism), bromocriptine, high-dose selegiline, and psychosurgery. Modern stereotaxic psychosurgical procedures offer symptom relief with minimal risk, and reports of large trials indicate that up to ... Read More
Management of treatment-resistant depression: strategies for treatment
Posted By Kelly On Saturday, March 6th 2010 under: Management Tags: Antidepressants, clomipramine-tryptophan-trd, Depression, Treatment
Common strategies for treatment resistance.
Electroconvulsive therapy
An important and effective treatment for depression, electroconvulsive therapy (ECT) is effective in about 90% of cases of major depression. The success rate drops when it is used for drug-refractory cases. Using ECT depends on patient-related factors: it clearly is the treatment of choice for depression with psychomotor slowing, stupor, psychotic symptoms, or depression requiring rapid response because of suicidal risk or malnutrition. Use of ... Read More
Management of treatment-resistant depression: Switching antidepressants
Posted By Kelly On Thursday, March 4th 2010 under: Management Tags: Antidepressants, Depression, depression-symptoms-chart, Treatment
If lithium augmentation is ineffective, it should be discontinued and the antidepressant changed (Table 5). A lack of response to one of the newer agents in a class, such as the selective serotonin reuptake inhibitors (SSRIs), does not predict lack of response to others in that class. If the first drug used was a reversible inhibitors of monoamine oxidase A (RIMA) with only one drug in the class, the ... Read More
Management of treatment-resistant depression (TRD)
Posted By Kelly On Tuesday, March 2nd 2010 under: Management Tags: Antidepressants, Depression, lithium-augmentation-success, lithium-success-in-treating-depression, Treatment
Major depression is best managed through a treatment algorithm. The more resistant to treatment a patient's illness is, the further treatment proceeds through the steps. As each trial of therapy is deemed ineffective, diagnosis should be reviewed and physical and psychosocial factors reassessed before making a decision about the next step. Psychotherapy is an essential accompaniment to any form of somatic treatment. Supportive psychotherapy offers reassurance and time for patients ... Read More
Management of Resistant Depression. Factors. Treatment Adequate.
Posted By Kelly On Sunday, February 28th 2010 under: Management Tags: Antidepressants, Depression, Mental Disorder, Treatment
Are there underlying physical factors?
Many physical diseases present with depressive symptoms or complicate depressive illness (Table 2). Some of these illnesses remain undetected for years and account for an apparent treatment-resistant depression (TRD). Normal thyroid function is particularly important; even mild or subclinical hypothyroidism can impair response to antidepressants. Hypothyroidism can be induced by lithium therapy, and many drugs, both medical and nonmedical, can cause depression or complicate treatment (Table ... Read More
Management of Resistant Depression. Subtypes of Depression
Posted By Kelly On Friday, February 26th 2010 under: Management Tags: Depression, lusert, lusert-drug, lusert-sertraline, Mental Disorder
More than 20% of patients with major depression have not recovered after 2 years and, of those who do initially recover, 20% suffer a relapse 1 year later. Most studies have shown that 60% to 70% of patients respond to the first antidepressant used and a further 10% to 15% respond either to a second antidepressant or to electroconvulsive therapy (ECT). About 15% of patients fail to recover even with ... Read More