Are we withholding the most effective treatment for severe depression from our patients?

2021 ◽  
Vol 27 (5) ◽  
pp. 303-304
Author(s):  
Angela McGilloway
Keyword(s):  
Effective Treatment ◽  
Cognitive Deficits ◽  
Antidepressant Medication ◽  
Severe Depression ◽  
Recent Advances ◽  
Rapid Effect

SUMMARYIn response to an article on recent advances in the use of ECT for depression, this commentary supports earlier and more extensive use of the treatment. It challenges the belief that ECT is associated with a higher risk of cognitive deficits and mortality and points out its rapid effect compared with antidepressant medication. It calls for clinicians to remain up to date regarding ECT and consider its opportune use in severe depression.

Treating Depression with SNRIs: Who Will Benefit Most?

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S11) ◽  
pp. 15-21 ◽  
Author(s):  
Michael T. Isaac
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Medication ◽  
Severe Depression ◽  
Antidepressant Activity ◽  
Noradrenergic System ◽  
Factors Influencing ◽  
Genetically Determined ◽  
Norepinephrine Reuptake ◽  
Better Than ◽  
Cyp 2D6

AbstractThere is evidence that the serotonin norepinephrine reuptake inhibitors (SNRIs) venlafaxine, milnacipran, and duloxetine, have probable superior antidepressant activity to most selective serotonin reuptake inhibitors (SSRIs), especially in more severe depression. Some patients, however, respond better than others to SNRIs. Several factors influencing response to milnacipran have been recently studied. The presence of certain polymorphisms related to noradrenergic neurotransmission has been shown to be related to different degrees or rapidity of response to milnacipran. In addition, patients with low pretreatment levels of plasma 3-methoxy-4-hydroxyphenylglycol have a better response to milnacipran. These recent genomic and neurochemical data confirm that milnacipran, in contrast to SSRIs and venlafaxine, has an impact on the noradrenergic system. Differences in metabolism determined by genetic variables in cytochrome P450 (CYP) 2D6 activity are a major determinant of venlafaxine levels to such an extent that genetically determined decreases in CYP 2D6 activity have been associated increased adverse effects. Milnacipran, which is not metabolized by the enzymes of the CYP system is not influenced by polymorphism of these enzymes. These preliminary data suggest that a patient's biochemical and pharmacogenetic characteristics may be useful in the future to help clinicians chose the most  effective antidepressant medication.

scholarly journals Usefulness of vortioxetine noted in depression secondary to hypoxic brain injury and residual cognitive deficits

2020 ◽  
Vol 10 ◽  
pp. 204512532094339 ◽  
Author(s):  
Syeda Maheen Ahsan ◽  
Syed Daniyal Ahsan ◽  
Osman Khalid ◽  
Hina Agha
Keyword(s):  
Brain Injury ◽  
Cognitive Deficits ◽  
Severe Depression ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Health Team ◽  
Remarkable Improvement ◽  
Hypoxic Brain Injury ◽  
Hypoxic Brain ◽  
Growing Body

We report on our experience of treating depression secondary to hypoxic brain injury with the antidepressant vortioxetine to share in the growing body of evidence. Our patient was referred to a community mental health team with depression, amotivation and memory difficulties following a myocardial infarction and cardiac arrest 2 years prior. Regardless of motor recovery, major cognitive deficits remained; however, neurorehabilitation was impossible due to severe depression. We tried vortioxetine in the light of two failed antidepressants and saw a remarkable improvement in mood, motivation and engagement.

Drug Utilization Review: A Description of Use for a Medicaid Population (Maryland) 1986–1994

1994 ◽  
Vol 22 (3) ◽  
pp. 247-251 ◽  
Author(s):  
Richard D. Baylis
Keyword(s):  
Ace Inhibitor ◽  
Mild Hypertension ◽  
Antidepressant Medication ◽  
Severe Depression ◽  
The Body ◽  
Utilization Review ◽  
Mild Case ◽  
Potassium Supplement ◽  
Medicaid Population ◽  
Antianxiety Drug

A relatively healthy forty-six-year-old woman with mild hypertension receives a prescription for an antihypertensive medication. One of the medication's adverse effects is its potential to cause severe depression. Four months later, she is diagnosed with anxiety, an early manifestation of depression. An antianxiety drug is prescribed, but her anxiety worsens. Her physician then diagnoses her as having a depressive disorder, and prescribes a new antidepressant medication. She is still on the same antihypertensive.A seventy-two-year-old man is given furosemide and digoxin to control a mild case of congestive heart failure and hypertension. Because furosemide deletes potassium from the body, his physician also places him on a potassium supplement. Six months later, the physician tells the patient to stop taking the furosemide and prescribes an angiotensin converting enzyme (ACE) inhibitor. An effect of ACE inhibitors is to reduce the body's excretion of potassium thereby reducing the digoxin's effectiveness.

scholarly journals Women with breast cancer taking chemotherapy: depression symptoms and treatment adherence

2014 ◽  
Vol 22 (5) ◽  
pp. 866-873 ◽  
Author(s):  
Bianca Fresche de Souza ◽  
Jéssica Andrade de Moraes ◽  
Aline Inocenti ◽  
Manoel Antônio dos Santos ◽  
Ana Elisa Bauer de Camargo Silva ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Depressive Symptoms ◽  
Antidepressant Medication ◽  
Severe Depression ◽  
Cross Sectional Study ◽  
Depression Symptoms ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Appropriate Treatment

Objective to verify depressive symptoms and adherence to chemotherapy among women with breast cancer who are served by the Pharmacy of the Chemotherapy Center of a university hospital.METHOD: cross-sectional study with quantitative approach conducted with 112 women receiving chemotherapy. Structured interviews guided by a script addressing socio-demographic, clinical and therapeutic information, the Morisky Test, and the Beck Depression Inventory were used to collect data.RESULTS: 12.50% and 1.78% of the patients experienced "moderate" and "severe" depression, respectively, while 10.59% did not use antidepressant medication. A statistically significant association was found between levels of depression and the use of antidepressants. Lack of adherence was identified in 46.43% of the participants.CONCLUSION: these findings show the need to regularly screen for depressive symptoms and for adherence to chemotherapy treatment among women with breast cancer, in order to provide early detection and appropriate treatment centered on patients, and to improve their quality of life.

Cognitive disorders: Searching for the circumstances of effective treatment: Introduction by the symposium organizer

1998 ◽  
Vol 4 (6) ◽  
pp. 593-594 ◽  
Author(s):  
LESLIE J. GONZALEZ ROTHI
Keyword(s):  
Effective Treatment ◽  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Training Programs ◽  
Graduate Training ◽  
Cognitive Disorders ◽  
Professional Organizations ◽  
Neurologic Disease ◽  
Implicit Belief ◽  
Graduate Training Programs

Cognitive deficits associated with neurologic disease or damage are quite common and they are known to negatively impact the lives of patients, caregivers and society at large. Unfortunately, documented effective rehabilitation of cognitive deficits is extremely scarce. In addition the concept of cognitive rehabilitation is usually viewed with tremendous skepticism. This pessimism is manifested in so many ways: It is found in the reluctance of skeptical physicians to refer patients to rehabilitation clinicians, it is seen in the reluctance of service payers to fund clinical efforts, it gets reflected in the graduate training programs which place cognitive rehabilitation in the lower echelons of curricular priorities, it underlies the dearth of funded programs in cognitive rehabilitation research, and it even permeates professional organizations and journals where “treatment studies” represent an extreme minority of presentations and articles. The most salient explanation for this therapeutic nihilism is the implicit belief that “everyone knows it doesn't work.”

scholarly journals Review on Antidepressant Medication

2019 ◽  
pp. 580-587
Author(s):  
Sudhir R. Kaulage ◽  
Kiran T. Aldar ◽  
Rahul P. Jadhav ◽  
Prakash D. Jadhav ◽  
Vishal D. Yadhav
Keyword(s):  
Treatment Options ◽  
Antidepressant Drugs ◽  
Antidepressant Medication ◽  
Severe Depression ◽  
Complete Recovery ◽  
Common Disease ◽  
Drug Induced ◽  
Supportive Psychotherapy ◽  
Synthetic Drugs ◽  
Depressive Episodes

Depression is a life-threatening, debilitating, and common disease affecting different segments of community. Chemical and synthetic drugs available to treat this disease cause many adverse effects and may lead to complete recovery in only 50% of patients. Antidepressants are effective and accessible treatment options that can reduce suffering and prevent relapse of symptoms. They are recommended as first line treatment options in moderate and severe depression or mild or sub threshold depression that has persisted despite other interventions All current antidepressants, with the exception of agomelatine, increase the transmission of the monoamines, particularly serotonin, nor adrenaline and dopamine. The antidepressants are crucial for the treatment of depressive episodes in the acute phase when untreated symptoms are at their worst. With long-term use, however, the brain sets to work compensating for the drug-induced changes with a process he calls oppositional tolerance. Antidepressant drugs are the mainstay for the treatment of depression. Usually, antidepressants are given in combination with some form of limited supportive psychotherapy.

scholarly journals Modelling the cost-effectiveness of pharmacotherapy compared with cognitive–behavioural therapy and combination therapy for the treatment of moderate to severe depression in the UK

2015 ◽  
Vol 45 (14) ◽  
pp. 3019-3031 ◽  
Author(s):  
L. Koeser ◽  
V. Donisi ◽  
D. P. Goldberg ◽  
P. McCrone
Keyword(s):  
Cost Effectiveness ◽  
Effective Treatment ◽  
Combination Treatment ◽  
Severe Depression ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Effective Treatment Option ◽  
Cognitive Behavioural ◽  
Cost Effective Treatment ◽  
The Cost

Background.The National Institute of Health and Care Excellence (NICE) in England and Wales recommends the combination of pharmacotherapy and psychotherapy for the treatment of moderate to severe depression. However, the cost-effectiveness analysis on which these recommendations are based has not included psychotherapy as monotherapy as a potential option. For this reason, we aimed to update, augment and refine the existing economic evaluation.Method.We constructed a decision analytic model with a 27-month time horizon. We compared pharmacotherapy with cognitive–behavioural therapy (CBT) and combination treatment for moderate to severe depression in secondary care from a healthcare service perspective. We reviewed the literature to identify relevant evidence and, where possible, synthesized evidence from clinical trials in a meta-analysis to inform model parameters.Results.The model suggested that CBT as monotherapy was most likely to be the most cost-effective treatment option above a threshold of £22 000 per quality-adjusted life year (QALY). It dominated combination treatment and had an incremental cost-effectiveness ratio of £20 039 per QALY compared with pharmacotherapy. There was significant decision uncertainty in the probabilistic and deterministic sensitivity analyses.Conclusions.Contrary to previous NICE guidance, the results indicated that even for those patients for whom pharmacotherapy is acceptable, CBT as monotherapy may be a cost-effective treatment option. However, this conclusion was based on a limited evidence base, particularly for combination treatment. In addition, this evidence cannot easily be transferred to a primary care setting.

Sign in / Sign up

Export Citation Format

Share Document