| ||
| ||
|
||
|
|
|
Depression Series (Part 2): My Antidepressant Doesn't Work - What Can My Psychiatrist Do?
Maria has been increasingly depressed for the past few years. She has tried at least four newer antidepressants but so far, she doesn't seem to respond. Unable to work, she's now feeling helpless and hopeless. Likewise, her family is discouraged. Frustrated and baffled by Maria's lack of progress, the family doctor refers her to a psychiatrist. What can the psychiatrist do to help Maria? The psychiatrist has several options in dealing with a treatment-resistant or refractory depression. First, Maria's psychiatrist can optimize the dose of her antidepressant. Maria has been taking low doses of antidepressants. In spite of her lack of response, the medication dosage has not been increased. To obtain a clinical response, her psychiatrist should increase the dose every two to three weeks. The antidepressant can be adjusted up to the maximum allowable dose if no or only partial response is observed. Second, her psychiatrist can choose to augment the effect of her antidepressant with another medication such as lithium, triiodothyronine (T3), or buspirone. Among augmenters, lithium and triiodothyronine have the best support from the literature. Despite lithium's efficacy, some doctors avoid this drug because it requires regular blood monitoring and has unfavorable side effect profile such as acne, tremors, and thyroid and renal dysfunction. Recently, studies have shown atypical neuroleptics such as olanzapine and risperidone to be good augmenters. In my opinion, further studies are necessary to establish these two drugs as standard augmenter. Indeed, research studies and clinical experience have found augmentation strategy to be effective. Third, combination strategy is worthwhile to try. Maria's psychiatrist can add another antidepressant to boost the effect of her current antidepressant. For instance, trazodone can be added to an SSRI (serotonin reuptake inhibitor e.g. citalopram). Literature suggests that combining two drugs with different mechanisms of action and drugs that involve several brain chemicals has resulted in clinical improvement. In this scenario, one antidepressant plus another antidepressant is equal to three, or four or even ten, not two. Fourth, the psychiatrist can switch from one antidepressant to another. Previous studies have shown that when making a switch, a drug should be replaced by a drug from a different class e.g. from SSRI to SNRI (serotonin and norepinephrine reuptake inhibitor e.g. venlafaxine), or from TCA (tricyclic agent e.g. nortriptyline) to SSRI. But recent studies show that switching drugs within the same class (e.g. SSRI to another SSRI) is just as effective. Fifth, Maria's psychiatrist can also treat other ongoing symptoms or drug-related problems that further complicate her depression. If she is anxious and agitated, then her psychiatrist should prescribe antianxiety drug (e.g. lorazepam) or if Maria is psychotic then adding an antipsychotic drug should help. Moreover, medication side effects (such as insomnia, dryness of mouth, constipation, etc.) that negatively affect Maria's compliance to the drug should be addressed promptly. Lastly, if despite above measures Maria doesn't respond to antidepressants, then electroconvulsive therapy should be entertained. Of course, this procedure should be done with her consent. In summary, Maria's psychiatrist can optimize the dose, augment or combine treatment, switch the medication, treat side effects and ongoing symptoms, or use electroconvulsive therapy for treatment-resistant or refractory depression. About The Author Copyright 2003. All rights reserved. Dr. Michael G. Rayel - author (First Aid to Mental Illness-Finalist, Reader's Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel pioneers the CARE Approach as a first aid for mental health. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores.
MORE RESOURCES:
Depression - Google News |
|
|
|
RELATED ARTICLES
How to Uncover the Reason You Cant Sleep Tonight If you are like me .. Use Alternative Medicine to Ease Depression Depression is a problem that faces many of us, young or old; baby boomers or generation X. We have a fast lifestyle, we're working between sixty and eighty hours a week and we have long commutes into the office keeping us away from our families. Tuning the Music Therapist Music so strongly evokes emotional responses that it is being more frequently employed in the context of psychotherapy as a powerful healing modality. As a novice in this field I inquired at a recent conference on music therapy as to how this tool effects healing in clients with emotional disorders. Recognizing Depression Depression is a serious issue. There are simply hundreds of thousands of people who deal with depression on a daily basis. Natural Treatment for Depression - Is There An Alternative? Many people who are suffering from mild to moderate depression, are choosing to either forego drugs entirely, or to supplement the minimum dosage their doctor will prescribe, with natural treatment for depression.This can include a number of lifestyle alterations, and even herbal treatment for depression. How Do You Know if You Have Manic-Depression Nancy was doing very well until about two years ago when Phil, her boyfriend of 9 years, broke-up with her. It was a difficult moment for her especially after she learned that Phil eventually married her cousin. Mood Disorders And Depression We all suffer with bad moods from time to time. But if you are someone who is in a bad mood or depressed much of the time, take heart. Depression After A Heart Attack There are several factors can lead to depression after heart attack. The stress of being in the hospital, the fear of another heart attack, time away from work can all contribute to feeling depressed, helpless, down and despondent. What Is God Thinking? What can you say to a parent who loses a child to cancer? Whatever words we offer are inadequate to lessen their sorrow. We have no answers to questions like, "Why this child?" or "Why now?" and "What do I do now?"Another question we all ask and cannot answer is, "Where was God and what was He thinking when this horrible thing happened? " For answers, I look to God's written word. Beating Stress, Anxiety and Depression Why are these illnesses on the rise? And why do some people become so ill through these illnesses, they can find it hard to function?Well they sure don't happen overnight! You don't suddenly wake up one morning and feel stressed or depressed. It's not like flicking on a light switch! And by the same rule, if you're suffering, you can't just wake up one morning, flick off the switch and say "Great, I'm better now. Depression and EPA Fish Oil - Does It Really Work? It is now no secret that people all over the western world are turning to high grade ethyl EPA omega 3 fish oil to treat a number of conditions, but can it really work against a problem that knows no boundaries of age, race or gender. It is a condition that affects millions of people at some time in there lives, it's called depression. Depression Mantra Depression is the most prevalent of all the emotional disorders. This may vary from feelings of slight sadness to utter misery and dejection. Neuromodulation Is Now The Mainstream Therapy For Chronic Depression The cover of the March 7, 2005 issue of Business Week titled REWIRING THE HUMAN BODY, describes how neuromodulation brings new hope to the four million desperate patients in the United States who suffer from the debilitating disease of chronic or treatment-resistant depression.The neuromodulation industry is just in its infancy and could double over the next several years as doctors are thrilled by this vision of the body electric. A Simple Cure For Anxiety And Depression Our innate desire is to be happy, and when we move away from it, we experience fear.This fear is actually millions of years old, for it arises from the biological programming of our species. Are the Benefits Worth the Costs? Schizophrenia suffers around the world have benefitted greatly with the discoveries of modern medicine. Certain medications have been found to regulate and balance brain chemistry giving an individual suffering from schizophrenia a seemingly normal life. 7 Things You Can Do Immediately To Ease Depression 1. Get out now and walk fifteen minutes. Mental Health Stigma - What Can We Do About It? What is Stigma? Stigma is the use of stereotypes and labels when describing someone, and it is often attached to people who suffer from mental health issues. We don't fully understand how the brain works yet, but one thing we DO know is that it is an organ. Aspartame and Your Mental Health In 1965, a chemist working to develop an ulcer drug accidentally discovered a substance 200 times sweeter than sugar. The FDA initially shunned this substance because it caused seizures and brain tumors in lab animals. What's The Latest on Suicide Risk and Antidepressants For Children? FDA confirms some antidepressants increase suicide risk in some children. In February of 2004, two advisory committees of the U. To Long Term Care Professionals: How to Dramatically Improve your Residents Psychiatric Care Long term care facilities and residents' doctors should consider combining medication treatment with psychological and behavioral approaches, such as strength-embedded psychotherapy, for a range of psychological disorders.Currently, psychiatrists and primary care providers in long term care are prescribing drugs and more drugs as the only treatment for psychological disorders.
|
| home | site map |
| © 2006 |
