(Country: Canada)
Miscellaneous Group
The drugs in the miscellaneous group which are most widely used are meprobamate and Librium.
Meprobamate is marketed under the trade names of Equanil, Miltown and Tranquiline. It has presented minimal toxic effects but has been misused by many people prone to drug addiction. The drug is essentially an effective medication for anxiety reactions but should be avoided, or at least used with considerable caution, in individuals with character disorders, alcoholism or previous drug addiction.
A new tranquillizer, unrelated chemically to any of the other drugs, is Librium. It would seem that this drug will be of value in anxiety states, neurotic depressions and obsessive-compulsive neuroses. The side effects are minimal, mainly in the form of drowsiness and ataxia which can be handled by lowering the dosage. These side effects are more likely to occur in elderly and debilitated patients and require caution in initial medication levels. The effect of Librium is the reduction of anxiety and tension; and in some cases stimulation may occur. Many patients have reported improved appetite and weight gain on this drug.
Antidepressants
There are many drugs available for use in the treatment of neurotic depression and fatigue states. Traditionally, the amphetamines such as Dexedrine and Benzedrine have been effective for this type of depression, mainly by producing euphoria and increased psychomotor activity. They are of little value in the more serious depressive illnesses, Side effects of tremor, palpitations and poor appetite occur. Methylphenidylacetate (Ritalin) is a most useful drug for the mild to moderate depressions and can be administered safely to the elderly patient and to patients with serious medical disabilities such as coronary artery disease. The side effects are minimal. Deanol (Deanor) is another drug without appreciable toxic effects which is of value in the neurotic depressions. Librium also shows considerable promise in its effect on depression.
For the psychotic depression, two groups of drugs are used: the amine oxidase inhibitors and imipramine (Tofranil). Iproniazid (Marsilid) was the first of the amine oxidase inhibitors to be introduced. This is an inhibitor of the enzyme monoamine oxidase. The resultant effect is an increase in brain serotonin which may affect neurohormonal control at the synapse. Iproniazid was found to be effective in psychotic depressions that had not responded to electroshock treatment and was considered to facilitate recovery in these depressions in conjunction with other methods of treatment. Serious toxic effects were reported, mainly in the form of liver cell damage and, in some cases, acute hepatic necrosis. It is felt, however, that these toxic effects were due to excessive dosage. The drug has subsequently been considered reasonably safe in lower dosage levels with close clinical supervision. Similar drugs of less, toxicitv have been marketed, namely, phenylzine di-hydrogen sulfate (Nardil) and nialamide (Niamid). Their indication and method of action are similar to those of iproniazid. Side effects of vertigo, dry mouth, perspiration, ankle edema and hypotension have been reported. Dosage levels in this group should be reduced to maintenance levels after two to three weeks with adequate medical supervision. In summary, the indications for the amine oxidase inhibitors are as follows:
(1) For the treatment of low-grade depression not requiring hospitalization and without suicidal risk.
(2) For the management of serious depression in hospital, usually in conjunction with electro-convulsive therapy.
Imipramine (Tofranil) is the other drug to be considered in this antidepressant group. It is closely related chemically to the phenothiazine group but has no action as a tranquillizer and is not an amine oxidase inhibitor. It does, however, increase the level of brain serotonin and has some action on the central nervous system function at the synapse. Its side effects include dryness of mouth, blurring of vision, hypotension, tachycardia, and with high dosage, urinary retention. In view of the hypotensive effect, it should be used with caution in elderly persons and patients with cardiac failure or coronary heart disease. Dosage levels of 25 mg. four times daily are adequate and it is doubtful if higher levels are of value. After recovery from the depression, maintenance treatment with 25 mg. daily should be carried on for one or more months.
Experience indicates that the more serious depressions will not respond to drug management within a short time and that hospitalization is advisable to protect the patient from suicide and to provide adequate care. Electroshock treatment is indicated in conjunction with drugs in this group for the severe depressions with suicidal drives and for the group of patients who do not respond satisfactorily after an adequate trial with medication alone.
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Hello, everybody, who is interested to be healthy. My name is Kelly. I learnt about depression by my own experience. Now I am ok. Here I want to share my thoughts and ideas how to treat depression symptoms.