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Pharmacotherapy of Depression
Domenic A. Ciraulo, Richard Shader
Verlag Humana Press, 2010
ISBN 9781603274357 , 423 Seiten
2. Auflage
Format PDF
Kopierschutz Wasserzeichen
Pharmacotherapy of Depression
3
Preface
5
Contents
7
Biological Theories of Depression and Implications for Current and New Treatments
13
Introduction
13
Neuroendocrine Systems
17
Hypothalamic Pituitary Adrenal (HPA) Axis in Depression CRF
17
HPA Axis, Anxiety, and Stress
18
Limbic-Cortical-Striatal-Pallidal-Thalamic (LCSPT) Tract, Stress,and Depression
18
Hippocampus: Possible Pivotal Role Among LCSPT Tract Structures?
20
Neuronal Plasticity and Brain-Derived Neurotrophic Factor (BDNF)
21
How Strong Is the Case for a Major Role of Stress and the HPA Axisin Depression?
21
The Hypothalamus–Pituitary–Thyroid (HPT) Axis, Growth Hormone, Somatostatin, and Prolactin in Depression
23
Classic Neurotransmitters and the Monoamine Hypothesisof Depression
25
Serotonin
26
Norepinephrine
27
Dopamine
28
Other Neuromodulators: Cytokines, Substance P, Glutamate, g.-Aminobutyric Acid, and Enkephalins
29
Alterations in Physiological Function: Circardian Rhythms, Sleep, Pain Perception, and Appetite
32
Conclusion
33
References
34
Clinical Pharmacology and Therapeuticsof Antidepressants
45
Introduction
45
General Principles
45
Pharmacokinetics and Pharmacodynamics
45
Pharmacogenetics
47
Practical Aspects of Treatment
49
SSRIs
58
History
58
Pharmacokinetics
58
Dosages (Table 7)
61
Mechanism of Action
62
Drug Interactions/P450 Metabolism
65
Adverse Effects
65
Overview
65
Gastrointestinal
67
CNS
67
Suicidality
68
Serotonin Syndrome
69
Endocrine System
69
Hematologic
70
Sexual
70
SSRI Discontinuation/Withdrawal Syndrome
72
Safety
72
Safety in Overdose
72
Safety in Pregnancy and Lactation (See Also Chapter “Diagnosisand Treatment of Depression During Pregnancy and Lactation”)
73
Efficacy
74
Cyclic Antidepressants
76
History
76
Pharmacology
76
Pharmacokinetics
77
Mechanism of Action
81
Adverse Effects
81
Cardiovascular: Orthostatic Hypotension
82
Cardiovascular: Conduction Effects
82
Sexual Dysfunction
83
Other Adverse Effects
84
Overdose
84
Clinical Use
85
Other Antidepressants
87
Bupropion
87
Venlafaxine
89
Duloxetine
91
Nefazodone and Trazodone
91
Mirtazapine
93
Overdose
94
The Role of Mixed Action Antidepressants in Therapeutics
95
Antidepressants Without United States FDA Approval
95
Reboxetine
95
Adverse Effects
96
Efficacy
96
Mifepristone
97
Substance P
97
Melantonergic Agents
98
Sigma Agonists
98
MAOIs
98
History
98
Pharmacology
99
Clinical Use
102
Adverse Effects
103
Hypertensive Crises
103
Drug–Drug Interactions
105
Overdose
105
Augmentation Strategies
106
Combinations of Antidepressants
106
Atypical Antipsychotic Augmentation of SSRI
107
Buspirone
108
Psychostimulants
108
Thyroid Hormone
109
Testosterone
110
Estrogen
110
Amantadine
112
Alternative and Non-Traditional Antidepressants
112
St John’s Wort
112
Adverse Effects
112
Drug–Drug Interactions
113
Efficacy
113
Conclusion
115
SAMe
115
Omega-3 Fatty Acids
116
Conclusion
117
References
118
Antidepressant Treatment of Geriatric Depression
137
Epidemiology
137
Phenomenology of Geriatric Depression
139
Diagnosis
140
Depression Subtypes and Comorbidity
142
Vascular Depression
142
Depression and Alzheimer’s disease
144
Depression and Cognitive Decline
145
Grief with Depression and Complicated Grief in the Elderly
146
Psychotic Depression
146
Suicidality
146
Depression with Concurrent Substance Abuse
147
Depression with Anxiety
148
Comorbidity Depression and Personality Disorders
148
Depression and Medical Illness
149
Treatment of Geriatric Depression
150
Pharmacological Treatment Issues
150
Physiology of Aging
152
Pharmacokinetics
152
Pharmacodynamics
155
Anticholinergic Adverse Effects
155
Cardiovascular Effects
156
Orthostatic Hypotension and Falls
157
Other Adverse Effects
158
Treatment of Major Depression
159
SSRIs
160
TCAs
166
Clinical Use of TCAs
169
Summary of Antidepressants in Geriatric Major Depression
170
Antidepressant Response in non-MDD Subtypes of Geriatric Depression
170
Treatment of Dysthymia and Subsyndromal Depression
170
Treatment of Depression with Insomnia
171
Treatment of Depression Comorbid with Dementia
171
Treatment of Complicated Grief
172
Treatment of Post-Stroke Depression
173
Electroconvulsive Therapy
174
Psychosocial Treatments
175
Conclusions
176
References
176
Treatment of Psychotic Disorders
196
Introduction
196
Prevalence and Course of Depression in Schizophrenia
196
Functional Consequences of Depression in Schizophrenia
198
Differential Diagnosis of Depression in Schizophrenia
198
Treatment
199
Atypical Antipsychotics
199
Electroconvulsive Therapy
200
Augmentation of Antipsychotics
200
Efficacy
200
Safety
202
Conclusion
203
References
204
Treatment of Bipolar Depression
208
Introduction
208
Scope of Depression in Bipolar Illness
208
Potential Reasons for Understudy of This Phase of the Illness
210
Implications for Treatment Recommendations
210
Second Generation Antidepressants: Their Limitations Despite Preference Over TCAs
211
Bupropion
213
SSRIs
213
SNRIs
214
Mirtazapine
214
Pramipexole
214
Use of Antidepressant in Depression Breaking Through Ongoing Treatment with a Mood Stabilizer: Duration of Treatment
215
Mood Stabilizers in the Treatment of Bipolar Depression
216
Lithium
217
Carbamazepine (Tegretol, Equetro)
218
Valproate (VPA, Divalproex Sodium, or Depakote)
219
Lamotrigine (Lamictal)
220
Gabapentin and Pregabalin
223
Topiramate (Topamax)
224
Other Anticonvulsants
225
Oxcarbazepine (Trileptal)
225
Levetiracetam (Keppra)
225
Zonisamide (Zonegran)
226
Tiagabine (Gabitril)
226
Second Generation Atypical Antipsychotic Agents
227
Clozapine
227
Risperidone
228
Olanzapine
228
Quetiapine
229
Ziprasidone and Aripiprazole
229
Superior Effectiveness of Atypical vs. Typical Antipsychoticsin Bipolar Depression
230
Sequential Treatment Approaches
231
Acute Episode
231
Supraphysiologic Thyroid Hormone Augmentation
232
Omega-3-Fatty Acids (OFAs)
233
Inositol
233
Focus on Long-Term Prevention
234
Other Therapies Including ECT, rTMS, and VNS
234
A Critical Role for Psychoeducation and Targeted Psychotherapy
236
Rationale for Early Detection and Intervention
236
References
238
Substance Abuse and Depression
249
Introduction
249
Prevalence and Comorbidity
250
Functional Consequences of Comorbid Depressionand Substance Abuse
254
Clinical Evaluation and Differential Diagnosis
255
The Importance of an Adequate History
255
MDD vs. Substance-Induced Mood Disorder
255
Evaluation for Suicide Risk
256
Dysthymia
256
Depression After Prolonged Sobriety
256
Clinical Presentations
257
Alcohol Dependence
257
Depression and Acute Intoxication
257
Alcohol Dependence and Depression
257
Alcoholic Hypophoria
258
Pharmacotherapy of Depression in the Alcoholic
258
Clinical Pharmacology of Antidepressants in Alcoholism
258
Initiating Pharmacotherapy
260
Tricyclic Antidepressants (TCAs)
260
Serotonin Reuptake Inhibitors (SSRIs)
263
Nefazodone
266
Mood Stabilizing Antidepressants
266
Cocaine
268
Opiates
271
Sec24_6
271
Depression and Opiate Detoxification
274
Treatment Failures
274
Conclusion
275
References
275
Antidepressant Treatments in PTSD
285
Posttraumatic Stress Disorder (PTSD)
285
Acute Stress Disorder
285
Disorders of Extreme Stress or Complex PTSD
286
Epidemiology of Trauma and PTSD
286
Prevalence of Traumatic Events
286
Comorbid/Cooccurring Disorders
287
Neurobiology of PTSD
289
Pharmacotherapy for PTSD
292
Antidepressant Treatment
292
SSRI Antidepressants
292
Fluoxetine
292
Paroxetine
293
Sertraline
294
Citalopam/Escitalopram
295
Fluvoxamine
296
SNRI Antidepressants
296
Venlafaxine
296
Duloxetine
297
Novel Antidepressants
297
Nefazadone
297
Trazadone
297
Mirtazapine
297
Buproprion
298
Monoamine Oxidase Inhibitors (MOA-Is)
298
Tricyclic and Tetracyclic Antidepressants
299
Summary of Antidepressant Treatment of PTSD
299
Nonantidepressant Somatic Therapies
300
Anxiolytics/Hypnotics
300
Mood Stabilizers
301
Older Agents
301
Newer Agents
302
Antipsychotics
303
Risperidone
303
Quetiapine
304
Olanzapine
305
Aripiprazole
305
Other Antipsychotics
305
Other Treatments
306
a2 Adrenoreceptor Agonists
306
a1 Adrenoreceptor Antagonists
306
Various Antagonists/Agonists
307
Prevention Medication
307
Repetitive Transcranial Magnetic Stimulation
308
Psychosocial Treatments
308
References
309
Diagnosis and Treatment of Depression During Pregnancy and Lactation
318
Depression and Pregnancy
318
The Risk of Being Depressed During Pregnancy
319
Risk Factors for Developing Depression During Pregnancy
321
The Risk to the Mother of Untreated Depression
322
Risk of Untreated Depression to the Fetusand to Pregnancy Outcome
324
The Effect of Untreated Depression on Pregnancy Outcome
324
The Risk of Pre-Term Labor/Delivery
324
Effect of Untreated Depression on the Course of Labor
325
The Impact of Untreated Depression on Fetal Development
326
The Impact of Stress and Anxiety on the Fetus
326
Effect of Stress on the Fetus
327
Effect of Depression or Stress on the Neonate
327
The Effect of Stress on Development
327
Fetal Programming and Its Relationship to Developmental Outcome
328
Prenatal Stress and Outcome: Animal Studies
328
Cortisol Stress and Fetal Programming
329
Treating Depression During Pregnancy
329
Pharmacologic Treatment of Depression During Pregnancy
330
The Risks and Benefits of Pharmacologic TreatmentDuring Pregnancy
330
Risk of Malformations
331
Risk of Spontaneous Abortion
334
Pre-term Birth and Fetal Growth Restriction (or Smallfor Gestational Age)
334
Impact of Antidepressants on the Neonate
335
Neonatal Adaptation
335
Persistent Pulmonary Hypertension
336
Non-SSRIs
337
Umbilical Cord Levels
337
Managing NAS
337
Developmental Risks
338
Prescribing Antidepressants During Pregnancy
339
Dosing Considerations During Pregnancy
339
Other Somatic Treatments
340
Electroconvulsive Therapy
340
Transcranial Magnetic Stimulation
341
Managing Mood Disorders in the Postpartum Period
342
Postpartum Blues and Postpartum Depression
342
Onset Prevalence and Risk Factors
342
Risk Posed by Postpartum Depression to Mother and Infant
344
Treating Postpartum Depression
344
Breast-Feeding
345
Choosing a Drug
348
Guidelines to Consider in Deciding on Continuing Medication (These Guidelines Are Adapted from di Scalea (244))
349
Conclusion
350
References
352
Antidepressant Treatment of Pediatric Depression
364
Introduction
364
Epidemiology
365
Diagnosis and Course
365
Research on Antidepressants in Child and Adolescent Depression
367
Fluoxetine
367
Sertraline
368
Paroxetine
369
Venlafaxine
370
Citalopram, Escitalopram
371
Other Second-Generation Antidepressants
371
Discussion: Application of Antidepressant Researchto Clinical Practice
372
The Current Safety Controversy on Child and Adolescent Depression Treatment
374
Advisories, Warnings, and Regulations on Youth Suicideand Antidepressants
374
Evidence of Possible Antidepressant-Related Suicidal Ideationand Behavior
375
Effect of FDA Warning on Antidepressant Prescribingand Suicide Rates
376
Discussion: The Current Antidepressant-Suicide Controversyand Clinical Practice
377
Recommendations for Clinical Practice with Childrenand Adolescents with Major Depression
378
Treatment Guidelines
379
References
379
Managing Depression in Primary Care
384
Introduction
384
Epidemiology
384
Diagnostic Screening in Primary Care
385
Overview
385
Screening Tools for Primary Care
386
Risk Factors as a Screening Consideration
387
Assessment and Differential Diagnosis
388
Bipolar Disorder
391
Risk Assessment
391
Symptom Severity Assessment
394
Management of Depression
396
Maximizing Treatment Outcomes
397
Treatment Approaches
398
Treatment Goals
400
Conclusion
401
References
402
Treatment of Depression in the Medically Ill
407
Introduction
407
Diabetes
408
Ischemic Heart Disease
409
Post-stroke
412
Dementia (See Also, Chapter “Antidepressant Treatmentof Geriatric Depression”)
415
Parkinson’s Disease
416
Conclusions
418
References
418
Index
423