Treatment Of Major Depression

It is often surprising for the student to learn that mood-elevating agents do not act as stimulants of the central nervous system (CNS). With the exception of varying degrees of sedation, the antidepressants have little effect on behavior early in treatment. During this period patients will, however, have side effects specific to the class and agent being used. Only after 2 to 3 weeks of dosing will a therapeutic benefit on depression emerge. At this point the patient begins to demonstrate elevation in mood and self-esteem. In addition, many of the vegetative signs of the illness (e.g., insomnia, anorexia) abate, and the patient regains an interest in daily activities. Failure to continue the medication, however, will result in an immediate relapse into the depressive state. Therefore, maintenance therapy must be continued for at least 6 months.

L TABLE 33.1 Half-Lives of Antidepressant Drugs

Drug (trade name)

Half-life (hr)


Amitriptyline (Elavil)

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