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

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

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

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

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

Brian Leonard and Paul Spenser, eds. Colchester: Portland Press, 1991, 516 pp ISBN 1-869868-74-9 The Royal College of Psychiatrists and the Royal College of General Practitioners launched a 5-year Defeat Depression Campaign on 30 January 1992. The first year of the campaign is intended to educate health professionals in the recognition and treatment of depression. This book, which is the proceedings of the Conference of the British Society for Psycho-Pharmacology held in Ireland in ... Read More

The American Psychiatric Association (1983) reports that recurrent episodes occur in at least 50% of patients who seek treatment for major depressive disorder (MDD). Most studies, though, have examined only single occurrences. To help describe the episodic nature of MDD, the National Institute of Mental Health initiated the Collaborative Program on the Psychobiology of Depression, a prospective, naturalistic, longitudinal investigation. This program's early research found the cumulative probability of recurrence ... Read More

Historically, St. John’s wort has been used as an herbal remedy for depression, anxiety, diuresis, gastritis and insomnia. Recent studies demonstrate that the extract, primarily hypericin, is a strong, and nearly irreversible, inhibitor of monoamine oxidase types A and B. Patient Presentation and History JS is a 37-year-old female who comes to the pharmacy intending to purchase St. John’s wort. She has heard that it can relieve depression, and she firmly believes ... Read More

Helping Your Depressed Teenager. A Guide for Parents and Caregivers Gerald D. Oster, Sarah S. Montgomery John Wiley & Sons Canada, Ltd, 5353 Dundas St W, 4th Floor, Etobicoke, ON M9B 6H8 1995/184 pp Strengths Very informative, logical presentation, useful bibliography and resource list Weaknesses Support groups mostly in the United States Adolescents are not just "big children" or "little adults." They represent a separate stage in the transition from infancy to old age. The authors have written an ... Read More

Question. I used to take 100 mg of imipramine per day for depression. Then I was diagnosed with mixed bipolar and was switched to 750 mg Depakote and 225 mg of Effexor per day. I gained about 50 pounds during the first three months and have not been able to lose any of it. I have a lot of problem with my weight and it has been starting to make ... Read More