Archive for March 23rd, 2009

posted by admin on Mar 23

Drugs that sometimes lead to major depression and dysthymia include:

• antihypertensive drugs such as reserpine, methyldopa, propranolol, guanethidine, hydralazine, and clonidine

• anti-infective drugs such as Cycloserine

• anti-Parkinson drugs including Levodopa, amantadine, and carbidopa

• corticosteroids

• estrogen and progesterone

• the anticancer drugs Vincristine and Vinblastine.

What are the risk factors that might predispose adolescents to becoming manic?

Risk factors that might lead to possible mania among adolescents taking Prozac are:

• a diagnosis of Bipolar I or II disorder

•a family history of affective disorders, and especially of bipolar disorders

• unstable mood of a milder degree

• major depression with psychotic features

• attention deficit hyperactivity disorder.

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posted by admin on Mar 23

Cognitive therapy is a short-term structured form of psychotherapy based on the idea that the way a patient perceives the world determines behavior. The tendency to see oneself, the world about one, and the future in a negative way often leads to depression, according to this school of thought. Treatment is aimed at altering these cognitive misperceptions by helping patients gather evidence to counteract this distorted view.

Behavioral therapy is a form of psychotherapy that aims to inhibit or extinguish “learned” neurotic responses. Techniques include assertiveness training, biofeedback, aversive therapy, conditioning, contract therapy, flooding, and desensitization. There are a limited number of reports that certain illnesses responsive to Prozac, including OCD and phobias, are more effectively treated with the combination of behavioral therapy and Prozac or older antidepressants man with medication alone.

Interpersonal Psychotherapy (IPT) is a three-part, time-limited therapy specifically designed to help alleviate major depression. During the first one to three sessions, the psychotherapist takes a psychiatric history and an .interpersonal inventory that focuses on the patient’s psychosocial problems. The middle phase of IPT focuses on the problems of the present (rather than the past) through a series of strategies designed to help the patient cope with grief, interpersonal conflicts, role transitions, and inadequate social skills. During the final phase, the therapist helps the patient learn to recognize and cope with symptoms of depression that might appear in the future.

Various studies have shown that IPT is an effective therapy for some forms of depression even without drugs. This is important because there are many instances in which depressed patients cannot take drugs. Some people are simply not responsive to drugs, some experience uncomfortable or even dangerous side effects, and some have other medical conditions that make taking the drug problematic (pregnancy might be one such condition). However, the best results, especially during the acute phase of major depression, came from the combination of cognitive therapy or IPT with an antidepressant medication.

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posted by admin on Mar 23

In no way is Prozac a substitute for lithium. Prozac is an antidepressant, and lithium is a mood stabilizer. Prozac has potent properties of relieving mild to major depression and perhaps prevents recurrent depression as well. At the same time, Prozac may induce mania or hypomania in patients who nave a bipolar manic depressive history but are not taking lithium.

Lithium, on the other hand, has a mild antidepressant effect in depressive disorders, a strong antimanic effect, and, finally, a prophylactic effect on both the highs and lows of bipolar illness and the lows of recurrent depression.

Although lithium is most successful in controlling manic highs, it does not always eradicate the depressive phases of bipolar disorders.

Has Prozac proven to be as effective long-term as lithium? Not yet Lithium, which offered the first effective, long-term treatment for manic depression, has been readily available in the United States since 1973 and was used as early as 1948 in Australia, 1954 in Denmark, and a few years later in England and Canada. Prozac was introduced to the American market in 1987. Consequently, lithium has been clinically evaluated for a much longer time in many more centers and studies around the world. Its uses are known. In many ways, Prozac is still being explored. Are there any long-term complications associated with Prozac or with the combination of Prozac and lithium? No long-term complications of Prozac are to date, although the full story is not in, since Prozac has only been on the market approximately seven years. Only after twenty or thirty years of closely observing a large number of patients taking an antidepressant can one make conclusions about any of its potential long-term complications.

Long-term effects of lithium have been identified, however. They include the possibility of goiter or altered thyroid function in a small percentage of patients. Some long-term lithium patients with previous kidney impairment tend to lose an even greater degree of kidney function over time. These patients should either switch to a lithium alternative such as Tegretol or Depakote, or be maintained on smaller doses of long-term lithium.

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posted by admin on Mar 23

This is an important question, because depression hits the elderly hard. Depression is four times more common among the elderly than in the general population and the suicide rate for people over 65 is fifteen times greater than that of the overall population.

Open studies and double blind studies indicate that Prozac relieves the symptoms of depression just as well as other antidepressants in geriatric r patients. Certainly, mild doses of nortriptyline (Aventyl or Pamelor) have been successful in elderly depressed patients in the opinion of many psychiatrists, and other psychiatrists may swear by any number of the older drugs as highly effective. However, patients taking Prozac complained less frequently of dry mouth and constipation, which are typically reported with other antidepressant drugs, and they were much less likely to drop out of the study due to adverse effects. Prozac also lacks adverse cardiovascular effects, compared to the tricyclic antidepressants, and is much less dangerous when taken in overdose. In the opinion of most psychopharmacologic experts, Prozac or one of the other SSRIs is the preferred antidepressant in the elderly.

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posted by admin on Mar 23

In thousands of patients studied in clinical trials before December 1987, Prozac was repeatedly found to induce weight loss, making it the first antidepressant ever marketed in the United States for which this is true. One study found that after six weeks, patients taking the older, tricyclic antidepressants gained about one pound while those on Prozac lost weight. And the heavier they were, the more they lost. Patients of normal weight lost about two pounds, while those considered obese dropped an average of seven pounds in six weeks. (After long-term treatment, the weight loss reached a plateau.) Other clinical trials show that after six weeks, patients of normal weight lost two to four pounds, while those who were overweight dropped an average of four pounds. In addition, about 13% of the patients in a controlled clinical trial lost more than 5% of their body weight while taking Prozac.

The explanation for the weight loss is simple: the patients ate less while on Prozac. But why they ate less is not agreed upon.

Although the weight loss Prozac produces is not enormous, it is statistically significant.

Many patients, especially women, are devastated when one of the older and well-known antidepressants causes their dress size to grow as their depression diminishes. Prozac, to the delight of most, has an opposite effect.

On the other hand, a small percentage of patients paradoxically gain weight, although this happens far less often than has been seen with tricyclic antidepressants. MAOI antidepressants, lithium, Depakote, and Tegretol, all of which are associated with some degree of weight gain in one-third of patients taking these medications.

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