| |
| |
|
Depression Information |
|
|
|
Depression Series (Part 2): My Antidepressant Doesn't Work - What Can My Psychiatrist Do?
Maria has been increasingly depressed for the past few years. She has tried at least four newer antidepressants but so far, she doesn't seem to respond. Unable to work, she's now feeling helpless and hopeless. Likewise, her family is discouraged. Frustrated and baffled by Maria's lack of progress, the family doctor refers her to a psychiatrist. What can the psychiatrist do to help Maria? The psychiatrist has several options in dealing with a treatment-resistant or refractory depression. First, Maria's psychiatrist can optimize the dose of her antidepressant. Maria has been taking low doses of antidepressants. In spite of her lack of response, the medication dosage has not been increased. To obtain a clinical response, her psychiatrist should increase the dose every two to three weeks. The antidepressant can be adjusted up to the maximum allowable dose if no or only partial response is observed. Second, her psychiatrist can choose to augment the effect of her antidepressant with another medication such as lithium, triiodothyronine (T3), or buspirone. Among augmenters, lithium and triiodothyronine have the best support from the literature. Despite lithium's efficacy, some doctors avoid this drug because it requires regular blood monitoring and has unfavorable side effect profile such as acne, tremors, and thyroid and renal dysfunction. Recently, studies have shown atypical neuroleptics such as olanzapine and risperidone to be good augmenters. In my opinion, further studies are necessary to establish these two drugs as standard augmenter. Indeed, research studies and clinical experience have found augmentation strategy to be effective. Third, combination strategy is worthwhile to try. Maria's psychiatrist can add another antidepressant to boost the effect of her current antidepressant. For instance, trazodone can be added to an SSRI (serotonin reuptake inhibitor e.g. citalopram). Literature suggests that combining two drugs with different mechanisms of action and drugs that involve several brain chemicals has resulted in clinical improvement. In this scenario, one antidepressant plus another antidepressant is equal to three, or four or even ten, not two. Fourth, the psychiatrist can switch from one antidepressant to another. Previous studies have shown that when making a switch, a drug should be replaced by a drug from a different class e.g. from SSRI to SNRI (serotonin and norepinephrine reuptake inhibitor e.g. venlafaxine), or from TCA (tricyclic agent e.g. nortriptyline) to SSRI. But recent studies show that switching drugs within the same class (e.g. SSRI to another SSRI) is just as effective. Fifth, Maria's psychiatrist can also treat other ongoing symptoms or drug-related problems that further complicate her depression. If she is anxious and agitated, then her psychiatrist should prescribe antianxiety drug (e.g. lorazepam) or if Maria is psychotic then adding an antipsychotic drug should help. Moreover, medication side effects (such as insomnia, dryness of mouth, constipation, etc.) that negatively affect Maria's compliance to the drug should be addressed promptly. Lastly, if despite above measures Maria doesn't respond to antidepressants, then electroconvulsive therapy should be entertained. Of course, this procedure should be done with her consent. In summary, Maria's psychiatrist can optimize the dose, augment or combine treatment, switch the medication, treat side effects and ongoing symptoms, or use electroconvulsive therapy for treatment-resistant or refractory depression. About The Author Copyright © 2003. All rights reserved. Dr. Michael G. Rayel - author (First Aid to Mental Illness-Finalist, Reader's Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel pioneers the CARE Approach as a first aid for mental health. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores.
MORE RESOURCES:
Depression - Google News |
|
|
|
RELATED ARTICLES
Adult Men and Women Who Suffer From Chronic Depression Market surveys on women, men and depression suggest an estimated 4.4 million Americans are believed to suffer from chronic treatment-resistant depression. Depression: One Womans Story Sharon was talking to a friend on the phone one night. When her friend asked, "How are you?" Sharon suddenly exploded with emotion. Depression The 'experts' have tried to evaluate me as a sufferer of this but found no such evidence or behavior. The same was true for all other mental or medical conditions, so they think 'witch' covers my condition in life; because I refuse to participate in the materially managed environment any more. Get Rid Of Depression Once And For All Depression is something that will occur in many people's lives, for various reasons. But the "normal" occurrence of a plunge in mood due to stressful events in your life, usually doesn't last very long, before a person's natural resilience responds to the environment of friends and family. Mental Health Stigma - What Can We Do About It? What is Stigma? Stigma is the use of stereotypes and labels when describing someone, and it is often attached to people who suffer from mental health issues. We don't fully understand how the brain works yet, but one thing we DO know is that it is an organ. What is Neurotransmitter Deficiency Disorder and How Can It Cause Depression, Anxiety, and... Neurotransmitters (NTs) are essential chemical messengers that regulate brain, muscle, nerve and organ function. The most common NTs are serotonin, dopamine, norepinephrine, and epinephrine. Tuning the Music Therapist Music so strongly evokes emotional responses that it is being more frequently employed in the context of psychotherapy as a powerful healing modality. As a novice in this field I inquired at a recent conference on music therapy as to how this tool effects healing in clients with emotional disorders. The Patients Guide to Vagus Nerve Stimulation and Depression INTRODUCTION Everybody has a story. My story is the one I know best and can write about. FDA Deems Vagus Nerve Therapy Approvable as a Treatment for Depression On February 3, 2005 the U.S. Surviving the Storms of Life August in Florida has a daily ritual that Floridians take with a grain of salt. It's the daily storms that pass by and that are filled with more electricity than in a 4th of July fire works display. Quick Steps To Improve Your Mood Looking to improve your mood?Edward W. Smith, motivational speaker, author and TV show host, who specializes in quick tips on how to move your life ahead even faster, offers the following advice. Depression: What It Is and What You Can Do About It There are three basic ways to treat depression: psychotherapy, self-help, and medication. Many people respond best to a combination of two or more methods. Depression: 14 Universal Laws for Recovery The Law of BlueJust sort of feeling blue, kinda out of it, gets confused with being depressed. We all get the blues from time to time, and they pass. I Love You, I Hate You But Dont Go: Understanding Borderline Personality Disorder It amazes me that 6-10 million Americans have been diagnosed with this isolating disorder. What's amazing about this is that not much is written about BPD much less talked about. Do You Think You Have Depression? Do you have days where nothing can make you happy? You are not alone. I ignored my depressive thoughts about life for years. FDA Nears Completion of Review of Vagus Nerve Stimulation For Chronic Depression On June 2 at 8:00 pm ET, Reuters news service issued a press release announcing that the FDA have nearly completed final review of the conditions outlined in the February "deemed approvable" letter for VNS Therapy as a treatment for chronic depression. Cyberonics Inc. Senate Finance Committee Delays FDA Approval of Vagus Nerve Stimulation Therapy for Depression On June 15th, 2004, FDA's Medical Devices Panel recommended that the U.S. What's The Latest on Suicide Risk and Antidepressants For Children? FDA confirms some antidepressants increase suicide risk in some children. In February of 2004, two advisory committees of the U. Vagus Nerve Stimulation and Depression Vagus Nerve Stimulation for Chronic or Treatment-Resistant Depression About Vagus Nerve Stimulation(VNS) VNS is not brain surgery, although it is a treatment that affects the function of the brain. Vagus Nerve Stimulation uses specific stimulation of the vagus nerve to send stimulation to specific parts of the brain that are involved in mood. New FDA Approved Therapy for Depression: Timeline from Prescription to Procedure On July 18, 2005, the U.S.
|
| home | site map |
| Web Site Development - Search Engine Marketing: Dream Team Media |
