Antidepressant Medication Strategies

Fluoxetine, best known by the trade name Prozac®, unlike other psychotropic drugs whose effects were serendipitously stumbled upon, was the first developed for a precise mechanism of action, that is, the ability to selectively inhibit serotonin reuptake, based upon the theory that increasing the availability of serotonin would treat major depression. Once approved by the FDA in 1987, fluoxetine quickly became the most prescribed psychotropic drug worldwide and its success in improving mood disorders has triggered the development of a large number of congener molecules, commonly known as SSRIs after their purported mechanism of action. However, a quarter of a century after its development, the idea that fluoxetine asserts its positive behavioral effect through inhibition of serotonergic reuptake is not firmly established. This book reviews several preclinical and clinical reports suggesting that the pharmacological effects of fluoxetine may be mediated by means other than the regulation of serotonin, including the regulation of gene expression, modifying epigenetic mechanisms as well as modifying microRNAs. One of the most prominent mechanisms for the therapeutic relevance of fluoxetine relates to influencing neuroplasticity by enhancing neurotropic factors, including BDNF signaling and altering adult neurogenesis. The ability of fluoxetine to rapidly increase neurosteroid levels accounts for the fast anxiolytic effects of this drug. Fluoxetine action at sigma-1 receptor or modulating glutamatergic neurotransmission as well as the combination of fluoxetine with other psychotropic drugs is discussed in relation to its therapeutic effects. While fluoxetine was primarily prescribed as an antidepressant, this drug currently represents a treatment of choice for a broad spectrum of psychiatric disorders, including post-traumatic stress disorder and a range of anxiety disorders. This drug even possesses analgesic actions and is a valuable therapy for stroke. This book also highlights emerging evidence on the gender-specific effects of fluoxetine, its potential adverse features, including its addiction liability in combination with psychostimulants, and the impact of perinatal fluoxetine exposure.

Do today's antidepressants really deliver what the pharmaceutical companies tout and what users expect?

Alternatives to standard drug treatments for this common problem. Depression is one of the most common issues that people bring to therapy. It is also a mental health condition with several well-known and readily available medications to treat it. That said, every clinician knows that medications do not work for all clients, and even if they do work they can often come with unwelcome side effects that are difficult and hard to bear. In short, medications are not foolproof. Fortunately today, with rising interest in non-drug approaches, effective and easy-to-implement alternative strategies exist for dealing with depression in your clients, either in conjunction with medication treatments or on their own. Six of the best are presented in this book. With his characteristic mix of insightful clinical anecdote and personal narrative, seasoned therapist Bill O’Hanlon lays out six of his go-to non-medication strategies for clinicians to use with their own depressed clients. These include “marbling” (training people to intersperse happy memories with sad ones so that over time they move away from a feeling of such negativity); challenging isolation in clients (helping them to see the benefits of the social world); and understanding neuroplasticity and how it can be used to your clients’ advantage. Bill O’Hanlon writes from a place of experience. As a youth, he was so severely depressed that he contemplated suicide. His successful rise from that dark place, some 30 years ago, can be seen as the starting point for this book. Many of the strategies he used to overcome his own illness he now puts forward here, with compassion and wisdom, so that other clinicians may benefit. Every depressed person experiences his or her own variety of the illness, and as therapists we need to help our clients discover their own paths to healing. Armed with the compelling, non-drug strategies in this book, clinicians will be able to do just that, opening up a new route to health and wellness. Whether you routinely prescribe psychotropic drugs or would never think of doing so, this book may offer just the advice you need to advance your therapy work and make a real difference in your depressed clients’ lives.

This manual attempts to provide simple, adequate and evidence-based information to health care professionals in primary health care especially in low- and middle-income countries to be able to provide pharmacological treatment to persons with mental disorders. The manual contains basic principles of prescribing followed by chapters on medicines used in psychotic disorders; depressive disorders; bipolar disorders; generalized anxiety and sleep disorders; obsessive compulsive disorders and panic attacks; and alcohol and opioid dependence. The annexes provide information on evidence retrieval, assessment and synthesis and the peer view process.

The World Health Organization defines depression as a primary contributor to the global burden of disease and predicts it will become the second leading cause of death by 2020. The need to develop effective therapies has never been so pressing. Current antidepressant drugs have several limitations. This 2010 book looks at the future of mood-disorder research, covering the identification of new therapeutic targets, establishing new preclinical models, new medicinal chemistry opportunities, and fostering greater understanding of genetic influences. These strategies are likely to help build a better picture of the disease process, and lead to new opportunities for patient stratification and treatment. The ultimate goal for this strand of research is to develop more personalized and effective treatments for this chronic and debilitating condition. This is essential reading for all those involved in psychopharmacologic drug development, and mental health clinicians seeking a preview of discoveries soon to influence their practice.

Treatment-resistant Depress Successful management of patients with treatment-resistant depression requires a thorough understanding of the biological basis for both the depression and its failure to respond to standard treatments. This book clearly and succinctly summarizes the latest scientific research and its applications in clinical practice. A first step is a clear definition of what constitutes treatment-resistant depression so that clinical trials and other studies are using common criteria, enabling comparison and meta-analysis of their outcomes. The opening chapter reviews definitions and predictors of treatment-resistant depression originating from different fields and discusses their usefulness in clinical practice and clinical research. The next chapter proposes a new definition, adapting terminology from medicine. Biological classification requires identification of genetic risk factors and gene variants have been identified as accounting for 50% of the variance in the clinical outcomes of antidepressant treatments. Chapter 3 describes several genes already associated with treatment-resistant depression and, while further work is needed to translate findings into clinical recommendations, suggests that genetic prediction of treatment resistance could become a widespread clinical reality within a few years. Most patients with treatment-resistant depression will be treated pharmacologically, so three chapters review the latest evidence for pharmacological best practice in switching strategies for antidepressants, the role of antipsychotics and augmentation strategies to complement lithium. There are two major alternatives to pharmacotherapy: neuromodulation and psychotherapy. The brain intervention chapter summarizes clinical research and experience with electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation and magnetic seizure therapy. The final chapter reviews the literature pertaining to the effectiveness of various forms of psychotherapy in patients who have not responded to antidepressant pharmacotherapy, explaining that patients who have not responded to one or two trials of antidepressant medication have a 30%-50% chance of responding to a focused psychotherapy. It proposes indications for psychotherapy in treatment-resistant depression and summarizes general therapeutic principles. Essential reading for all psychiatrists managing patients with this distressing disorder.

In this book, leading-edge investigators offer effective strategies to improve current antidepressive therapies and suggest molecular, biological, and genetic approaches that will lead to the development of novel antidepressants. The contributors' critical reviews and commentaries illuminate our understanding of the mechanism(s) responsible for antidepressant action. The book's goal is to move beyond current biogenic amine-based concepts and therapies to the development of new and improved antidepressants that are more effective and have a more rapid onset than current.

Now in paperback, the second edition of the Oxford Textbook of Critical Care is a comprehensive multi-disciplinary text covering all aspects of adult intensive care management. Uniquely this text takes a problem-orientated approach providing a key resource for daily clinical issues in the intensive care unit. The text is organized into short topics allowing readers to rapidly access authoritative information on specific clinical problems. Each topic refers to basic physiological principles and provides up-to-date treatment advice supported by references to the most vital literature. Where international differences exist in clinical practice, authors cover alternative views. Key messages summarise each topic in order to aid quick review and decision making. Edited and written by an international group of recognized experts from many disciplines, the second edition of the Oxford Textbook of Critical Careprovides an up-to-date reference that is relevant for intensive care units and emergency departments globally. This volume is the definitive text for all health care providers, including physicians, nurses, respiratory therapists, and other allied health professionals who take care of critically ill patients.

Guiding clinicians toward the most effective treatment regimens, this reference offers detailed coverage of the symptomatology, diagnosis, epidemiology, and etiology of depression. A must-have tool for anyone prescribing psychotropics or performing psychotherapy, this source expertly reviews research and clinical data regarding acute and long-term