Managing Depression in Clinical Practice

Edward S Friedman

Language: English

Pages: 96

ISBN: 1849964645

Format: PDF / Kindle (mobi) / ePub

Managing Depression in Clinical Practice provides an overview of the clinical manifestation, diagnosis and management of this debilitating condition. The text offers practical coverage of depression in special populations, long-term treatment, and the management of treatment non-response.

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condition and the individual. Deliberately giving a placebo drug is unethical (outside a clinical trial with informed consent) and the effects are not consistent. Maximizing nonspecific beneficial effects is, however, an important (and large) part of the overall effect of treatment and should not be overlooked. Spontaneous improvement and placebo effects are greatest in milder degrees of depression and smaller when the disorder is more severe and/or chronic. In the mildest degrees of depression,

and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA 2007; 297:1683–1696.PubMedCrossRef 13. Lotrich F, Pollack B. Aging and clinical pharmacology: Implications for antidepressants. J Clin Pharmacol 2005; 45:1106–1122.PubMedCrossRef 14. Food and Drug Administration. Clinical Review: Relationship between antidepressant drugs and suicidality in adults. Department of Health and Human Service, FDA, Center for Drug Evaluation and

imipramine, and clomipramine) are more potent 5HT blockers, whereas secondary amines (nortriptyline, desipramine, protriptyline) are more effective on NE. Other effects are anticholinergic and antihistaminergic. Tertiary amines are metabolized to secondary amines; for example, amitriptyline to nortriptyline, imipramine to desmethylimipramine (desipramine). Desipramine has been largely superseded by more modern compounds but is still available in the USA. TCAs have high toxicity and fatality in

and the presence of a comorbid personality disorder [13]. There are no absolute contraindications, although those with unstable cardiac disease (e.g., ischemia or arrhythmia), cerebrovascular disease (e.g., recent cerebral hemorrhage or stroke), or increased intracranial pressure are at increased risk for complications [20]. Phototherapy Phototherapy – the use of light treatment – was developed to treat, and has become the first-line treatment for, individuals with seasonal affective disorder

approved for treatment of depression in the USA in October 2008, becoming the second stimulation treatment thus far approved for depression treatment in the USA. Deep brain stimulation DBS also has FDA approval for the treatment of epilepsy and is being studied for the treatment of depression [36]. In DBS, electrodes are surgically implanted in the subgenual cingulate area, also known as Brodmann area 25. This area of the anterior cingulate cortex has been shown to be metabolically overactive

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