Treatment
Mild, moderate and severe depressive illness are treated in similar ways and the principal decision is whether to treat with anti-depressant drugs or a talking therapy i.e. counselling etc.
Drug treatment
Drug treatment is usually effective in moderate and severe episodes of depressive illness. Approximately 60% of patients will respond to the first antidepressant prescribed.
Mood modifying drugs
Mood modifying medication is medication prescribed to improve or stabilise mood, mental status or behaviour and includes antidepressants, anti-mania drugs [e.g. Lithium], anti- anxiety drugs [e.g. Diazepam], anti-psychotic drugs [e.g. Haloperidol], stimulants [e.g.amphetamines] and sedatives [e.g. Temazepam].
Mood stabilising drugs
Mood stabilising medication is medication prescribed to stablise mood. It is used to treat bi-polar affective disorder (manic depression) and severe depression. They include: -
- Lithium [Camolit, Liskonum, Priadel, Li-Liquid]
- Carbamazepine [Tegretol]
- Sodium Valproate [Valproic acid]
Anti-depressant drugs
There is a wide and increasing range of antidepressant drugs available, varying in their side effects.
Non-compliance with antidepressants may reach 50%. Reasons for non-compliance include side effects encountered, perceived lack of effectiveness, lack of motivation and limited insight into illness.
Current recommendations are that antidepressant treatment should be continued for 6 months following remission, however emerging evidence suggests continuing treatment for 9-12 months following remission. Following this, antidepressants should be withdrawn gradually over 3 months.
In those with onset of a severe depressive episode after 50 years of age, or with three previous episodes of depressive illness, it is recommended that antidepressant medication is continued indefinitely.
There are a number of different drugs available. The choice of drug depends upon the preference of the individual doctor, taking into account factors such as side effects and cost. The individual drugs are listed below [trade name in brackets] together with some of the more common side effects.
- Citalopram [Cipramil]
- Fluoxetine [Prozac]
- Fluvoxamine [Faverin]
- Paroxetine [Seroxat]
- Sertraline [Lustral]
Side effects include nausea, diarrhoea, headache, insomnia, agitation and sexual dysfunction. Some of the following medicines may cause adverse effects if suddenly stopped.
- Amitriptylline [Lentizol]
- Amoxapine [Asendis]
- Clomipramine [Anafranil]
- Dosulepin/Dothepin [Prothiaden]
- Doxepin [Sinequan]
- Imipramine [Tofranil]
- Lofepramine [Gamanil]
- Nortriptylline [Allegron, motipress, motival]
- Trimipramine [Surmontil]
Side effects include; irregularity of heart rhythm, low blood pressure, drowsiness, convulsions, hence dangerous in overdose and can cause death. They can also cause blurred vision, dry mouth, constipation and urinary retention. All of these can reduce compliance with treatment. Drowsiness and blurred vision may be dangerous for those who drive, operate machinery or work at heights.
More recently introduced medicines include the following: -
- Venlafaxine [Efexor, Efexor XL]
- Reboxetine[Edronax]
- Mirtazapine [Zispin]
- Moclobemide [Manerix]
- Brofaromine
- Cimoxatone
- Toloxatone.
- Mianserin
- Maprotiline
- Trazodone [Molipaxin]
- Flupenthixol/flupentixol [Fluanxol]
Tryptophan [Optimax]
This antidepressant drug can only be prescribed by hospital specialists for people with severe and disabling depressive illness of more than 2 years duration and only after an adequate trial of standard antidepressant medication, due to potential severe blood disorder that can result from taking the drug.
Lithium
The evidence for using lithium in unipolar depressive illness is less clear than in bipolar disorders. It can be effective as an added medicine when other measures have failed, e.g. in people who have not responded to a standard antidepressant drug by itself.
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Amended December 2010
