Depression

2011 ◽  
Vol 26 (S2) ◽  
pp. 2186-2186
Author(s):  
S. Kasper
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Course Of Illness ◽  
Biological Variables ◽  
Treatment Of Depression ◽  
Imaging Results ◽  
First Time ◽  
Underlying Pathophysiology ◽  
Unique Mechanism ◽  
Minor Side Effect ◽  
Volume Size

Depression is one of the thoroughly evaluated diseases in psychiatry with regard to diagnosis as well as treatment variables. Like in other medical conditions, early treatment should be aimed and watchful waiting which is for instance also not done in the treatment of high blood pressure or diabetes, has not been proven to be a sophisticated approach based on neurobiological considerations. Like in other diseases, it is apparent that days of untreated depression may result in brain damage like reduced volume size of the hypocampus. The course of illness of depression shows that life events are less important in later stages of the illness than in earlier. The introduction of the group of selective serotonin reuptake inhibitors (SSRI) marked a revolution in the treatment of depression, since it was possible to treat patient for the first time effectively with a more minor side effect profile with this approach. Substantially more patients could be reached and the association with this phenomenon and the reduction of the suicide rates in different countries like Sweden, Austria and Hungary has been discussed. Dual reuptake inhibitors effecting both the serotonergic as well as the noradrenergic pathways and the dopaminergic noradrenergic medication bupropion have been introduced in the filed with specific angles of treatment goals like pain or somatic symptoms. With the introduction of agomelatine, a unique mechanism of action with the combination of melatonergic agonistic as well as serotonergic antagonistic activities has been achieved. With this approach a more potent influence on the circadian rhythm has been shown compared to other, previously used antidepressant properties. Deep brain stimulation and vagus nerve stimulation for treatment refractory depressed patients yield promising results. More thorough characterisation of the underlying pathophysiology of depression including brain imaging results as well as molecular biological variables will yield further inside of the understanding and treatment of depression.

scholarly journals Treatment patterns and sequences of pharmacotherapy for patients diagnosed with depression in the United States: 2014 through 2019

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
David M. Kern ◽  
M. Soledad Cepeda ◽  
Frank Defalco ◽  
Mila Etropolski
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Medication ◽  
The United States ◽  
Treatment Patterns ◽  
First Line ◽  
Inpatient Hospitalization ◽  
Class Level ◽  
Treatment Of Depression ◽  
Antidepressive Treatment

Abstract Background Understanding how patients are treated in the real-world is vital to identifying potential gaps in care. We describe the current pharmacologic treatment patterns for the treatment of depression. Methods Patients with depression were identified from four large national claims databases during 1/1/2014–1/31/2019. Patients had ≥2 diagnoses for depression or an inpatient hospitalization with a diagnosis of depression. Patients were required to have enrollment in the database ≥1 year prior to and 3 years following their first depression diagnosis. Treatment patterns were captured at the class level and included selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, other antidepressants, anxiolytics, hypnotics/sedatives, and antipsychotics. Treatment patterns were captured during all available follow-up. Results We identified 269,668 patients diagnosed with depression. The proportion not receiving any pharmacological treatment during follow-up ranged from 29 to 52%. Of the treated, approximately half received ≥2 different classes of therapy, a quarter received ≥3 classes and more than 10% received 4 or more. SSRIs were the most common first-line treatment; however, many patients received an anxiolytic, hypnotic/sedative, or antipsychotic prior to any antidepressive treatment. Treatment with a combination of classes ranged from approximately 20% of first-line therapies to 40% of fourth-line. Conclusions Many patients diagnosed with depression go untreated and many others receive a non-antidepressant medication class as their first treatment. More than half of patients received more than one type of treatment class during the study follow up, suggesting that the first treatment received may not be optimal for most patients.

Anxiolytics

2018 ◽  
Author(s):  
Shadi Doroudgar ◽  
Gurjit Bains
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Alternative Therapy ◽  
Term Therapy ◽  
Key Points ◽  
Long Term Therapy ◽  
Pharmacologic Agents ◽  
Underlying Pathophysiology

The underlying pathophysiology of anxiety disorders revolve around neurotransmitter transmission, the pharmacologic target of common medication treatments. Pharmacologic treatment of anxiety disorders generally consists of benzodiazepines for short-term relief of anxiety symptoms and antidepressants as a long-term therapy. Benzodiazepines use should be limited because of habit-forming properties, dependence, and risk of adverse effects. Antidepressants are the typically preferred initial agents for long-term use due to efficacy and lack of dependence. Anxiety disorders may occur as comorbidities with other psychiatric disorders. Other pharmacologic agents are utilized as alternative therapy for patients who do not respond to mainstay therapy or are not candidates for the treatment with antidepressants. This review contains 1 figure, 6 table and 77 references Key Points: anxiety disorders, benzodiazepines, generalized anxiety disorder, norepinephrine, panic disorder, social anxiety disorder, selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors

scholarly journals Debris Disk Science with the Palomar ExAO System: First Results

2013 ◽  
Vol 8 (S299) ◽  
pp. 72-73 ◽  
Author(s):  
Matthew Wahl ◽  
Stanimir Metchev ◽  
Rahul Patel ◽  
Eugene Serabyn ◽  
Dimitri Mawet ◽  
...  
Keyword(s):  
Adaptive Optics ◽  
Scattered Light ◽  
Outer Ring ◽  
Imaging Results ◽  
First Results ◽  
Debris Disk ◽  
First Time ◽  
Adaptive Optics System

AbstractWe present first imaging results from the PALM-3000 adaptive optics system and PHARO camera on the Hale 5 m telescope. Observations using a vector vortex coronagraph have given us direct detections of the two-ring dusty debris system around the star HD 141569. Our observations reveal the inner clearing in the disk to unprecedentedly small angular separations, and are the most sensitive yet at the H and K bands. We are for the first time able to measure and compare the colors of the scattered light in the inner and outer dust rings, and find that the outer ring is significantly bluer than the inner ring.

scholarly journals Importance of Proactive Treatment of Depression in Lewy Body Dementias: The Impact on Hippocampal Neurogenesis and Cognition in a Post-Mortem Study

2017 ◽  
Vol 44 (5-6) ◽  
pp. 283-293 ◽  
Author(s):  
Ariana Gatt ◽  
Antigoni Ekonomou ◽  
Alyma Somani ◽  
Sandrine Thuret ◽  
David Howlett ◽  
...  
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Cholinesterase Inhibitors ◽  
Lewy Bodies ◽  
Hippocampal Neurogenesis ◽  
Acetyl Cholinesterase ◽  
Hippocampal Dentate Gyrus ◽  
Treatment Groups ◽  
Treatment Of Depression ◽  
The Impact ◽  
Ssri Treatment

Objective: To examine the impact of selective serotonin reuptake inhibitors (SSRIs) and depression on neurogenesis and cognition in dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD). Methods: Late-stage progenitor cells were quantified in the subgranular zone (SGZ) of the hippocampal dentate gyrus of DLB/PDD patients (n = 41) and controls without dementia (n = 15) and compared between treatment groups (unmedicated, SSRIs, acetyl cholinesterase inhibitors [AChEIs], combined SSRIs and AChEIs). Results: DLB/PDD patients had more doublecortin-positive cells in the SGZ compared to controls. The doublecortin-positive cell count was higher in the SGZ of patients treated with SSRIs and correlated to higher cognitive scores. Conclusion: SSRI treatment was associated with increased hippocampal neurogenesis and preservation of cognition in DLB/PDD patients.

Everyday Problems in Treating Depression: Focus on SNRIs

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S11) ◽  
pp. 4-4 ◽  
Author(s):  
Siegfried Kasper
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Activity ◽  
New Class ◽  
Treatment Of Depression ◽  
Norepinephrine Reuptake Inhibitor ◽  
Dual Action ◽  
Everyday Problems ◽  
Serotonin Norepinephrine Reuptake Inhibitor ◽  
Poor Tolerability ◽  
Norepinephrine Reuptake

Most effective antidepressants directly or indirectly increase the synaptic concentrations of serotonin (5-HT) and/or norepinephrine (NE) by blocking the reuptake of one or both of the neurotransmitters. This property was initially discovered with the tricyclic antidepressants (TCAs). Their various additional interactions at different receptors and ion channels are not required for antidepressant action, but are responsible for the poor tolerability and toxicity in overdose of the early antidepressants.The selective serotonin reuptake inhibitors are effective and well tolerated. Selective norepinephrine reuptake inhibitors, such as reboxetine, also have proven antidepressant activity. A selective action on one or the other of the principal monoamines thus appears to be sufficient for antidepressant activity. The idea that a dual action on both neurotransmitters might produce greater efficacy in certain patients led to the development of the serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants, which block the reuptake of both 5-HT and NE without the nonspecific, side-effect–inducing interactions of the TCAs. The three SNRIs—venlafaxine, milnacipran, and duloxetine—constitute a new class of antidepressants.Antidepressant response rates rarely exceed 60% to 70% and remission rates are usually <50%. Although SNRIs clearly provide superior efficacy in certain populations, their use has not dramatically changed antidepressant therapy. The search for agents that are more effective, rapidly acting, and better tolerated continues. However, clinicians must find ways to better use the antidepressants that are available today. This supplement, based on a symposium held at the International Forum on Affective Disorders in Budapest in December 2007, discusses several everyday problems in the treatment of depression, with a focus on SNRIs.

Recent Developments in Geriatric Psychopharmacotherapy

1994 ◽  
Vol 39 (8_suppl) ◽  
pp. 9-18 ◽  
Author(s):  
Alastair J. Flint
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Bipolar Affective Disorder ◽  
Unipolar Depression ◽  
The Elderly ◽  
Blood Levels ◽  
Pharmacological Management ◽  
Treatment Of Depression ◽  
Recent Developments ◽  
Psychiatric Complications

This paper highlights recent advances in the pharmacological management of geriatric affective disorders and dementia. The current roles of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) in the treatment of depression in old age are discussed. Recent findings pertaining to continuation and maintenance of antidepressant treatment are also addressed. The treatment of bipolar affective disorder in the elderly has received much less study than has unipolar depression. A number of issues relating to efficacy, side-effects and optimal blood levels of lithium, carbamazepine and valproate in bipolar disorder remain unresolved and await further study. Finally, drug treatment of the cognitive impairment and psychiatric complications of Alzheimer's disease is reviewed.

Treatment of Depression in Acute Coronary Syndromes with Selective Serotonin Reuptake Inhibitors

Drugs ◽  
2006 ◽  
Vol 66 (16) ◽  
pp. 2095-2107 ◽  
Author(s):  
Joost P van Melle ◽  
Peter de Jonge ◽  
Maarten P van den Berg ◽  
Harm J Pot ◽  
Dirk J van Veldhuisen
Keyword(s):  
Serotonin Reuptake ◽  
Acute Coronary Syndromes ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Treatment Of Depression ◽  
Coronary Syndromes

scholarly journals Prescribing patterns of antidepressants in Europe: Results from the Factors Influencing Depression Endpoints Research (FINDER) study

2008 ◽  
Vol 23 (1) ◽  
pp. 66-73 ◽  
Author(s):  
Michael Bauer ◽  
Brigitta U. Monz ◽  
Angel L. Montejo ◽  
Deborah Quail ◽  
Nicolas Dantchev ◽  
...  
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Medication ◽  
Prescribing Patterns ◽  
First Episode ◽  
Recurrent Depression ◽  
Related Factors ◽  
Physical Conditions ◽  
Factors Influencing ◽  
Treatment Of Depression ◽  
Tetracyclic Antidepressants

AbstractAntidepressant prescribing patterns and factors influencing the choice of antidepressant for the treatment of depression were examined in the Factors Influencing Depression Endpoints Research (FINDER) study, a prospective, observational study in 12 European countries of 3468 adults about to start antidepressant medication for their first episode of depression or a new episode of recurrent depression. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed antidepressant (63.3% patients), followed by serotonin-norepinephrine reuptake inhibitors (SNRIs, 13.6%), but there was considerable variation across countries. Notably, tricyclic and tetracyclic antidepressants (TCAs) were prescribed for 26.5% patients in Germany. The choice of the antidepressant prescribed was strongly influenced by the previous use of antidepressants, which was significantly associated with the prescription of a SSRI (OR 0.64; 95% CI 0.54, 0.76), a SNRI (OR 1.49; 95% CI 1.18, 1.88) or a combination of antidepressants (OR 2.78; 95% CI 1.96, 3.96). Physician factors (age, gender, speciality) and patient factors (severity of depression, age, education, smoking, number of current physical conditions and functional syndromes) were associated with initial antidepressant choice in some models. In conclusion, the prescribing of antidepressants varies by country, and the type of antidepressant chosen is influenced by physician- as well as patient-related factors.

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