Supplemental Reading

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American Psychiatric Association. Practice guidelines for major depressive disorder (MDD) in adults. Am J Psychiat 2000;157(Suppl 4):1-45.

Blier P and Abbott FV. Putative mechanisms of action of antidepressant drugs in affective and anxiety dis-

orders and pain. J Psychiat Neurosci 2001;26(1):37-43.

Feighner JP. Mechanism of action of antidepressant medications. J Clin Psychiatr 1999;60:4-11.

Goodnick PL and Goldstein BJ. Selective serotonin inhibitors in affective disorders: I. Basic pharmacology. J Psychopharmacol 1998;12:S5-20.

Greden JF. The burden of recurrent depression: causes, consequences, and future prospects. J Clin Psychiatr 2001;62:22:5-9.

Janicak PG, Davis JM, Preskorn SH, and Ayd FJ Jr. Treatment with Antidepressants. In Principles and Practice of Psychopharmacotherapy (3rd ed.). Philadelphia: Lippincott Williams & Wilkins, 2001.

^ Case Study Treatment of Depression

Mary Smith is a 46-year-old secretary who complains to her primary care physician mainly of fatigue. She reports having low energy over the past 2 months and finding it more and more difficult to maintain her home and work responsibilities. Although tired, she is unable to sleep through the night and awakens several times each night. Her appetite has been low and she has lost 10 pounds over this time. Her husband has noticed that she has lost interest in her hobbies and has withdrawn from their friends. He is concerned that she now has to bring office work home because her impaired attention and concentration make it impossible for her to complete her assignments during the workday. On this visit, Ms. Smith is neatly dressed, appropriate in conversation, but worried about why she has become unable to execute her tasks at work and enjoy her family and friends. She becomes tearful when describing this, feels guilty, and describes her mood as down. She expresses concern that she may not get better and has had thoughts of death but no actual plan or intent to end her life. She drinks no alcohol and doesn't use recreational drugs. She has no active medical problems and takes no prescription medications. Ms. Smith has one sister with a history of major depression, successfully treated with sertraline. Her mother was treated for depression with imipramine and phenelzine. Physical examination produces normal findings. Thyroid testing, blood counts, and blood chemistry are normal. Ms. Smith meets the DSM-IV criteria for major depression (depressed mood, loss of interest in pleasurable activities, decreased attention and concentration, fatigue, sleep disturbance, low appetite, weight loss, ideas of death). What pharmacological approach would you recommend?

Answer: Because of sertraline's favorable side effect profile and no need for dietary restrictions, it probably should be chosen over the older agents (TCAs and MAOIs). She should be warned about nausea and possibly loose stools, anorgasmia, and insomnia before she begins therapy. It also should be explained that the medication will take at least 2 weeks to begin working and that a complete trial of the medication to assess its efficacy will take 4 to 6 weeks. Since this is her first episode of depression, she should take the medication for 6 to 12 months after her symptoms have remitted before considering discontinuation of drug therapy.

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Defeat Depression

Defeat Depression

Learning About How To Defeat Depression Can Have Amazing Benefits For Your Life And Success! Discover ways to cope with depression and melancholic tendencies! Depression and anxiety particularly have become so prevalent that it’s exceedingly common for individuals to be taking medication for one or even both of these mood disorders.

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