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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Selegiline is a selective monoamine oxidase inhibitor used in the treatment of Parkinson's disease. It is estimated that approximately one-half of Parkinsonian patients will develop depression requiring antidepressant drug treatment. Recently, selegiline's package insert was revised to reflect the potential risk of adverse effects when it is used in combination with selective serotonin reuptake inhibitors and tricyclic antidepressants. The objective of our study is to assess the safety of combining selegiline with antidepressants. A retrospective chart review was performed on all 28 patients with Parkinson's disease receiving selegiline and antidepressants concurrently to identify possible drug interactions. Compliance was assessed according to prescription refill records. Suspected adverse reactions with combination therapy were documented. There was a total of 40 selegiline-antidepressant drug combinations involving tricyclic antidepressants (n = 25), selective serotonin reuptake inhibitors (n = 7), trazodone (n = 5), and bupropion (n = 3). One patient receiving fluoxetine developed a reaction consistent with the serotonin syndrome; however, it was never documented as such. No other selegiline drug interactions were found. Adverse effects noted were typical of antidepressant monotherapy. Although no selegiline drug interactions were documented in our study, the concurrent administration of selegiline and selective serotonin reuptake inhibitors should be avoided because of literature-reported interactions. We believe that bupropion, tricyclic antidepressants, and trazodone are reasonable choices in combination with selegiline, although tricyclic antidepressants and trazodone may be reserved as second-line treatments.
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PMID:Retrospective study of selegiline-antidepressant drug interactions and a review of the literature. 916 31

Depression and anxiety disorders are common in primary care. Diagnosis is accomplished by applying of specific, data-driven diagnostic criteria published in the DSM-IV. The differential diagnosis is sometimes difficult, but as a general rule the treatment of choice for both conditions is antidepressant medicine. It is very important to remember that anxiety disorders respond very nicely to most antidepressants, but depression does not respond to tranquilizers. BZs, should be reserved for adjunctive use in the early stages of treatment for both anxiety disorders and depression. The azapirone, buspirone, may be used as first line treatment for generalized anxiety disorder and may also augment antidepressants when the patient presents with mixed anxiety and depression. The important point is that when in doubt about either the diagnosis or which drug to choose first it is generally safe to select one of the newer antidepressants discussed in this article.
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PMID:Depression & anxiety in the primary care setting. 923 90

Flat adenomas are small, barely visible, raised lesions, sometimes with a central depression, which may be markers for a familial risk of cancer. Severe dysplasia is found in nearly half the cases. Carcinomas usually considered as occurring de novo may develop from flat adenomas. Detection of flat adenomas is difficult and substantially increases the duration of colonoscopy; therefore it should be reserved for high risk families. The stains and instruments needed to detect flat adenomas are detailed herein, as well as the excision technique.
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PMID:[Flat adenoma. Endoscopic aspects]. 933 8

Patients receiving antidepressant monotherapy may be partially or totally resistant to treatment in 10 to 30 percent of cases. In patients who have experienced only partial treatment results, the clinician should first consider optimizing antidepressant dosage or lengthening therapy. Antidepressant drug substitution should generally be reserved for use in patients who haven't responded at all (nonresponders). Combining two or more antidepressants is generally not recommended, as this approach may obscure adequate monotherapy evaluation and lead to significant adverse effects or drug-drug interactions. Use of electroconvulsive therapy is recommended in patients with psychotic and severe refractory depression. Augmentation therapy is often efficacious in patients who exhibit a partial antidepressant response. Lithium and thyroid hormone have been the most extensively studied augmentative agents but, more recently, pindolol and buspirone have also been used for this purpose.
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PMID:Practical management of treatment-resistant depression. 986 79

The utility of gabapentin and lamotrigine for the treatment of bipolar disorder is reviewed. Bipolar disorder is characterized by extreme mood fluctuations, including mania, hypomania, depression, and mixed episodes. Extrapolation of postulated mechanisms of anticonvulsant activity in bipolar disorder has led to the use of the newer anticonvulsants gabapentin and lamotrigine for therapy. Both agents appear promising on the basis of limited (often anecdotal) evidence. They may prove effective in patients with difficult cases of bipolar disorder, such as patients with rapid cycling, mixed episodes, and illness refractory to other treatments. Lamotrigine may offer a much-needed treatment alternative for bipolar depression and could be found effective for acute mania, but the need for slow dosage adjustment and the risk of rash may limit overall clinical utility. Gabapentin may offer significant advantages for acute mania: The dosage can be adjusted rapidly, adverse effects are generally minimal, the therapeutic index is high, there is no required laboratory monitoring, and there is minimal potential for interactions with other psychotropics. Until the results of randomized controlled trials are known, however, these two agents should be reserved for patients with bipolar disorder unresponsive to traditional therapies and for patients who cannot tolerate traditional agents. Preliminary evidence indicates that gabapentin and lamotrigine may be useful for the treatment of bipolar disorder.
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PMID:Gabapentin and lamotrigine in bipolar disorder. 1055 11

When performing IVCS, one must never forget the primary goal of providing patient comfort without compromising cardiopulmonary function or the patient's ability to react purposely to verbal commands and physical stimuli. When it is anticipated that required sedation will lead to loss of protective airway reflexes, such patients require a greater level of care than exists with IVCS. Deep sedation is a complication of IVCS and must be avoided. In deep sedation, one creates a state of depressed consciousness from which the patient is not easily aroused, accompanied by a partial or complete loss of protective reflexes, including the ability to maintain a patent airway independently and respond purposely to physical stimuli or verbal commands. In keeping this goal in mind, understanding those situations in which patients are at increased risk should be emphasized. In general, the elderly show increased sensitivity to the drugs used for IVCS, so the dose and frequency of administration should be reduced. In addition, patients with COPD appear to be more sensitive to the respiratory depressant effects of narcotics and benzodiazepines, especially when used in combination. Patients with low serum albumin concentrations show increased sensitivity to drugs that are highly protein bound such as thiopental because more free drug is available for therapeutic effect. To avoid hypotention, caution should be exercised in patients with poor left ventricular function or borderline volume status before the administration of IVCS. Understanding the metabolism and excretion of the agents used for IVCS is critical to avoid oversedation. Drugs such as diazepam, morphine, meperidine, and fentanyl have active metabolites, so the potential for drug accumulation and prolonged effect certainly exists. Patients with renal disease are particularly susceptible to CNS toxicity from normeperidine because of the accumulation of the active metabolite. Drugs like fentanyl, although short acting, have prolonged activity as a result of seepage of stored drug back into the systemic circulation. In contrast, thiopental is metabolized to water-soluble inactive metabolites. Careful titration to effect with dosage adjustments will avoid unnecessary oversedation with resultant respiratory and cardiovascular complications. Time should elapse between repeat doses to allow peak effects to occur. In addition, potential drug interactions that can prolong the effects should be recognized. Examples of the latter are the interaction between cimetidine and diazepam or the protease inhibitors and the benzodiazepines, in which the potential exists for excessive and prolonged sedation. The use of the narcotic antagonist naloxone and the benzodiazepine antagonist flumazenil should be scrutinized because they should be reserved for the unusual situation in which excessive cardiopulmonary depression occurs. Maintenance of a patent airway and stable cardiovascular function in a patient who can respond to verbal commands and physical stimuli is the primary goal of IVCS. With the agents discussed in this chapter, this goal is easily obtained, keeping the principles just mentioned in mind with all the appropriate monitoring guidelines discussed elsewhere in this text.
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PMID:Pharmacology. 1061 19

Although an increased recognition of depressive disorders in youth represents a positive conceptual change over the past decades, there still is a very limited amount of research on useful treatment interventions. The paucity of data is particularly keen for the use of psychotropic drugs. For example, by applying the criteria suggested by the International Psychopharmacology Algorithm Project, there barely are enough first-grade ("Level A," meaning at least two RCTs) data supporting the short-term efficacy of antidepressants (the SSRIs) in the treatment of juvenile depression. And yet, limited data have not translated into limited use in routine clinical practice. In fact, the use of antidepressant medications has increased exponentially over the last decade, a change that is especially conspicuous for individuals less than 18 years of age. The perceived safety of the SSRIs and other novel antidepressants is partly at the root of their increased popularity. Data regarding their safety are likewise quite limited, however, and essentially are nonexistent for longer-term use. Based on the reviewed data, a medication algorithm for the treatment of early-onset depression can be suggested (Fig. 1). The algorithm underscores the need for adequate evaluation and diagnostic assessment, with particular attention to comorbid conditions (such as a bipolar diathesis) that may dictate alternative treatment strategies. In general, psychotherapy is the initial approach to juvenile MDD, with medication use reserved for more severe cases or those not responding to psychotherapy alone. Given that only two types of psychotherapy and two SSRIs have adequate controlled short-term efficacy data, all but the initial steps must be undertaken guided by clinical judgment and an individualized risk-benefit analysis. An algorithm such as this one, based on the very limited efficacy and safety data available, may be viewed as setting priorities for a comprehensive research agenda, more than dictating rigid treatment guidelines. In closing, it can be suggested that future research on the pharmacotherapy of early-onset depressive disorder pay particular attention to the following three aspects: 1. Too many drugs, too few data: Rapid advances in drug development have led to a plethora of available antidepressant agents. It is clear that there are many more agents available than can be adequately studied at present. Because many such agents are mechanistically similar, if not identical, it may be wise to focus research efforts on truly novel agents, particularly those (such as the CRH receptor antagonists, or those affecting neurosteroidogenesis) whose action is based on preclinical and clinical pathophysiologic disease paradigms. 2. Longitudinal follow-up and maintenance studies: Essentially all reviewed treatment studies have been short-term trials. There is a marked paucity of longer-term follow-up data, or of naturalistic and "real-world" effectiveness studies. For example, one of the few studies addressing maintenance pharmacotherapy for early-onset depression has demonstrated surprisingly high recurrence rates, even for those subjects actively on maintenance medication. 3. Long-term safety: Clinicians and parents alike often face difficult decisions regarding the long-term exposure of antidepressant drugs on the developing brain. Although no definitive long-term safety data are likely to become available anytime soon, real risks, such as suicide, and potential sequelae of long-term exposure to the underlying illness itself need all to be part of any decision-making process. Preclinical studies have shown that brain-derived neurotrophic factor (BDNF) levels can be upregulated by antidepressants, and low BDNF factors have been associated with atrophic brain changes in recurrent forms of adult MDD. Although these observations require specific application to juvenile forms of the disorder, they raise the exciting prospect that the natural course of the illne
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PMID:Pharmacotherapy of early-onset depression. Update and new directions. 1067 94

70-90% of depressive patients are treated by their own family doctors. Recognising and treating depression is an important daily problem for family doctors. The severity of the disorder decides whether non-pharmacological therapy or pharmacotherapy is preferable. The choice and dosage of an antidepressant is dictated by the severity and the symptomatology of the disorder as well as the expected adverse effects. Not least on account of their low rate of adverse effects, phytotherapeutic agents are enjoying growing popularity among patients and thus assure high compliance. The use of herbal preparations is useful, in particular for mild to moderate depression in young patients or patients with a reserved attitude toward "chemical drugs". Of all phytopharmaceuticals St.-John's wort has been most widely scientifically documented for the treatment of depression.
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PMID:[Treatment of depression with St. Johns wort in general practice]. 1119 97

Best Supportive Care (BSC) is the treatment of choice when cure is not achievable with anticancer treatments and involves management of disease-related symptoms. In the palliative treatment of non-small cell lung cancer (NSCLC) radiation therapy has for a long time been the cornerstone of symptom management, although the best schedule is still to be defined. Chemotherapy, on the other hand, has been excluded from classical definitions of BSC and has been reserved only for selected patient populations in which a survival benefit was demonstrated using cisplatin-based regimens. We reviewed randomized trials on both palliative radiotherapy and chemotherapy in order to assess the impact of anticancer treatments on quality of life in advanced NSCLC patients. While no randomized trials compared radiation therapy with a control arm not including it, several randomized trials assessed the use of different schedules. Hypofractionated schedules seem to have comparable palliative activity when compared with the standard fractionated regimens, at least in metastatic, poor-prognosis patients. In locally advanced, inoperable NSCLC higher radiation doses administered with conventional fractionation achieve better results in terms of local control and survival. The rate of palliation of local symptoms is high, being 60-80% for chest pain and hemoptysis, while breathlessness and cough are controlled at a somewhat lower rate (50-70%). General symptoms (fatigue, anorexia, and depression) are affected in a minority of patients. Chemotherapy was compared with BSC in several randomized trials, in some of which an analysis of the quality of life was included. Results are consistent in favor of its palliative role and, when local symptom control is assessed, rates of palliation seem similar to those achieved by radiation. Benefits apply to metastatic NSCLC patients with good performance status, low body weight loss, age below 70-75. However, some studies support the use of chemotherapy also in patients with poor prognostic features. A comparison in terms of quality of life and symptom palliation between different chemotherapy regimens is the object of few trials. Both chemotherapy and radiation have an important role in the palliative treatment of advanced NSCLC patients and should be included in BSC programs. Future randomized trials should assess the best way of combining these two approaches.
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PMID:Best supportive care in non-small cell lung cancer: is there a role for radiotherapy and chemotherapy? 1139 3

Taking as a starting point a letter to Freud, in which Abraham revealed that personal motives had played a significant role in his study of the personality and work of the painter Giovanni Segantini, the paper offers an alternative reading of Abrahams personality to that usually given in the literature. With due circumspection, considering the hazards associated with applying the psychoanalytic method to a person who is in no position to respond to interpretations, either positively or negatively, the author suggests that Abraham may have fought a silent, lifelong battle against depression. She suggests further that the reserved and somewhat obsessional character traits, so often stressed in contemporaries' accounts of Abraham's personality, could be seen to be a defence against ambivalence and depressive affect, as Abraham himself described theoretically. In an examination of the Segantini study taken in conjunction with hitherto neglected details from Abraham's life as described in Hilda Abraham's biography of her father - especially the suggestion that his mother suffered a depression in his second year of life, following the death of her father and the loss of an unborn child in an accident - an attempt is made to deepen and widen the familiar, somewhat one-dimensional view of Abraham's personality, which the author finds difficult to reconcile with his astonishing creativity and productivity. Attention is paid both to the similarities and the considerable differences between Abraham and Segantini.
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PMID:[Karl Abraham and Giovanni Segantini]. 1162 48


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