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Depression Treatment

December 6, 2006
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Topics Covered in This Depression Treatment Article:

Medications

An inadequate or incomplete trial of an antidepressant medication, the preferred medication for use in depressive disorders, is often correlated with increased suicide rates. [17] [18] [19] Patient compliance with medication is a larger concern than often realized, especially when prescribed by a family physician. [20]

Selective serotonin re-uptake inhibitors (SSRIs) are the most commonly prescribed medication for depression today. Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) and Luvox (fluvoxamine) are the most commonly prescribed brand names, but SSRI medications should not be prescribed in conjunction with the older MAOIs (more popular in Europe than in the U.S.). (Allow for at least 5 weeks while switching in between these two classes of antidepressant medications.) There have been few long-term studies conducted on SSRI medication to ensure their safety and effectiveness given for anything longer than a few months at a time. FDA approval was received on these medications after study trials lasting only 8 to 12 weeks. [45] Care should be utilized when taking these medications for more than a year.

The following information should be used with care by physicians. It is presented here as only one physician’s opinion based upon his experiences with these medications. Phillip W. Long, M.D. writes,

Failure Of A Drug Trial

If an antidepressant has been used for four weeks at maximal dosages without a therapeutic effect, the clinician should consider either: (1) trying another antidepressant, (2) supplementing the current antidepressant with lithium or liothyronine (T3 or L-triiodothyronine) (Cytomel), (3) supplementing the SSRI antidepressant with a tricyclic antidepressant, (4) supplementing or replacing the current antidepressant with carbamazepine (Tegretol), (5) supplementing the current antidepressant with d-amphetamine (Dexedrine) or methylphenidate (Ritalin), (6) supplementing the antidepressant with phototherapy if the patient has seasonal major depression, (7) supplementing the antidepressant with an antipsychotic medication if the patient has a psychotic major depression, (8) trying electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS), or (9) stopping pharmacotherapy and proceeding only with psychotherapy.

Research has shown that adding lithium or liothyronine (T3 or L-triiodothyronine) (Cytomel) to an antidepressant often is successful in overcoming nonresponse. The addition of 25-50 mcg/day of liothyronine (T3 or L-triiodothyronine) (Cytomel) to an antidepressant regimen for 7 to 14 days may convert antidepressant nonresponders into responders. The adverse effects of T3 are minor but may include a headache and feeling warm. If T3 augmentation is successful, the T3 should be continued for two months and then tapered at the rate of 12.5 mcg a day every three to seven days.
[35] [36]

Anticonvulsants carbamazepine (Tegretol) and valproate (Epival, Depakote, Depakene) have been found effective in preventing the return of major depression [5] [38]. Two psychostimulants, d-amphetamine (Dexedrine) and methylphenidate (Ritalin), have also been found to be effective in the treatment of major depression when used to augment antidepressant medication [39]. Patients with psychotic depression usually require an antipsychotic medication in addition to their antidepressant regimen. The antipsychotic medication can be tapered and stopped when the psychosis has subsided.

[41]

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