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09.04.2015

Antidepressants for depression, tinnitus facts - Reviews

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A shocking article was recently published in the New York Times on the April 19th discussing the evolution and effectiveness of current antidepressants as treatment for Major Depression.
Displayed in the article are some very surprising findings, some of which refer to how many of the clinical trials of current antidepressants have produced results that do not show them to be significantly more helpful in treating Major Depression than a placebo (sugar pill). Depression, and that the current treatments that we have for Major Depression could be achieved by almost the same amount by the patient only taking a placebo pill. We encourage you to fill out the form above to be contacted by one of our specialized research staff members. Remember: by participating in one of our studies or clinical research trials, you'll be helping science take the necessary steps towards finding answers for others in the future!
ABSTRACT: Depression in the elderly significantly affects patients, families, and communities. Depression is the most common mental health problem in the elderly[1] and is associated with a significant burden of illness that affects patients, their families, and communities and takes an economic toll as well. Because of our aging population, it is expected that the num­ber of seniors suffering from depression will increase. There is also often a tendency for people to see their symptoms as part of the normal aging process, which they are not. The Geriatric Depression Scale (GDS) is a well-validated screening tool for depression in the elderly that comes in two common formats: the 30-item (long form) and 15-item (short-form) self-rating scale. The CCSD relies on an interview with a family member or caregiver as well as with the patient, and is validated for use with nondemented and demented depressed elderly. TreatmentThe current Canadian practice guidelines for the treatment of depression in the elderly were developed by the Canadian Coalition for Seniors’ Mental Health (CCSMH) in 2006.[1] They were created by experts in the field, are evidence-based, and include both pharmacological and nonpharmacological strategies.
Note that most depression studies have been conducted on younger populations, and when mixed-aged groups have been studied older adults have been underrepresented. If older adults are unresponsive to low doses of antidepressants, higher doses may be required to achieve a therapeutic effect. Choice of antidepressantFortunately there are several antidepressants that have been shown to be efficacious in elderly patients being treated for a major depressive episode without psychotic features. The selective serotonin reuptake inhibitors (SSRIs) and the newer antidepressants buproprion, mirtazapine, moclobemide, and venlafaxine (a selective norepinephrine reuptake inhibitor or SNRI) are all relatively safe in the elderly.
Of the SSRIs, fluoxetine is generally not recommended for use in the elderly because of its long half-life and prolonged side effects. Many medical conditions seen in the elderly, such as dementia, Parkinson disease, and cardiovascular problems can be worsened by a tricyclic antidepressant.
Also, it is recommended that an ECG and postural blood pressure reading be obtained before starting a patient on a tricyclic antidepressant and after increasing the dose.[1] Tricyclic antidepressant blood levels should be monitored since tricyclics are associated with more toxicity and since blood levels can be high despite low doses because some patients can be slow metabolizers.
Given the side effect profile and high rates of drug-drug interactions, monoamine oxidase inhibitors (MAOIs) are not considered first- or even second-line agents for depression in the elderly. DosingOnce an antidepressant is selected for an older patient, the starting dose should be half that prescribed for a younger adult[1] in order to minimize side effects. It is also important at each visit to monitor for any worsening of depression, emergence of agitation or anxiety, as well as for suicide risk, especially in the early stages of treatment.
Treatment to remissionAccording to the current CCSMH guidelines, if there is no improvement in depressive symptoms after 4 weeks or insufficient improvement in symptoms after 8 weeks on the maximum recommended or tolerated dose of an antidepressant, then the antidepressant should be changed.
Cross-titrating can be done—weaning the patient off the old antidepressant while introducing the new one—although caution is needed to ensure that there are no interactions between the two antidepressants. If there is significant improvement but not full remission after 4 weeks on the optimized antidepressant, the recommendation is to wait another 4 weeks and then consider add-on treatment if remission is still not achieved.[1] Add-on options include either an antidepressant of a different class, another agent such as lithium, or psychotherapy such as cognitive-behavioral therapy or interpersonal therapy. Newer pharmacological approachesSince the CCSMH guidelines document was published in 2006, newer antidepressant agents have become available including duloxetine and desvenlafaxine, both SNRIs. Atypical antipsychotics used as add-on therapy in the treatment of depression shows some promise.


The latest 2009 CANMAT national practice guidelines for the treatment of major depressive disorder in adults[28] recommend the use of atypical antipsychotic agents such as rispiridone, olan­zapine, and aripiprazole as first-line add-on agents in the treatment of depression, while quetiapine is recommended as a second-line add-on agent owing to fewer studies.
Nonetheless, atypical antipsychotics may prove to be an effective treatment for severe or refractory depression in the elderly who fail to respond fully to other medications. Together, these strategies can help promote the safe use of antidepressants in the elderly. AcknowledgmentsI would like to thank Dr Martha Donnelly for her encouragement and support in the preparation of this manuscript. The company compiled data from seven major markets for this drug category and found total sales to be $10.9 billion in 2010.
The report notes that physicians tend to be very willing to prescribe more than one drug for depression, so combination therapy is quite common. Explore the complexities of the biosimilars’ landscape, such as naming, interchangeability and substitution, differences in the manufacturing processes, as well as the approval pathways & FDA guidelines for biologics, including draft guidance on biosimilars. According to the article, there is a fear developing that antidepressants are no longer producing the depression relieving miracles as they have been thought to produce in the past and that the cause for this may be related to the drugs not resolving the true causes of Clinical Depression and other Major Depressive Disorders. What this article has brought about is a two-sided debate about how scientists should conduct future research for Depressive Disorders so that we are sure to be treating for the real cause of Major Depression rather than some linked factors. If not, then it affirms that our previous convictions about the origins of Clinical Depression have been false and need to get more at the heart of the reason why millions and millions of individuals are suffering from depressive psychological illnesses. The other side, however, argues that the differences in the study results between placebo and antidepressants are significant enough to continue administering our current antidepressant medications, and are even more significant in the instances of patients with severe levels of Depression and to avoid relapse.
Awareness of predisposing and precipitating factors can help identify patients in need of screening with tools such as the Geriatric Depression Scale. However, it is necessary first to identify and diagnose depression, which can be challenging in this population owing to communication difficulties caused by hearing or cognitive impairment, other comorbidities with physical symptoms similar to those of depression, and the stigma associated with mental illness that can limit the self-reporting of depressive symptoms. Depression in the elderly still goes undertreated and untreated, owing in part to some of these issues. In choosing an antidepressant it is recommended that selection be based on the best side effect profile and lowest risk of drug-drug interactions.
They have lower anticholinergic effects than older antidepressants and are thus well tolerated by patients with cardiovascular disease. Increased side effects from antidepressant use in the elderly are thought to be due to changes in hepatic metabolism with aging, concurrent medical conditions, and drug-drug interactions. Thus, it is important to schedule regular follow-up visits to monitor treatment response while assessing for side effects and titrating accordingly. For example, if fluoxetine is being discontinued, then a wash-out period of several weeks is recommended because of the drug’s long half-life. If a second antidepressant is added, monitor for the emergence of serotonin syndrome, which can arise if both medications are serotonergic. However, the CANMAT recommendations are based on studies of younger adults and are not intended for the elderly. Atypical antipsychotics at the lowest doses for symptom control are also recommended for the treatment of psychotic symptoms associated with depression. Besides medications, other therapies for depression that might be considered include various forms of psychotherapy and neurostimulation, with electroconvulsive therapy still being the gold standard for severe or psychotic depression. National guidelines for seniors’ mental health: The assessment and treatment of depression. Nonetheless, the antidepressant market is set for steady expansion, according to Datamonitor, a drug information company. By 2020, the market is forecast to grow to $14 billion in the seven markets: the United States, Japan, France, Germany, Italy, Spain, and the United Kingdom.
It has been long thought by researchers that the causes of depression come from the weak transmission of signals between the neurons in the brain.


However, some scientists are questioning whether we have jumped the gun by making the conclusion that the sole cause of Clinical Depression and other Major Depressive Disorders is solely the result of chemical imbalances in the brain. Furthermore, it questions the use of current antidepressants for treatment and whether or not they should be administered. It is his belief that taking many of the antidepressants that we see on the market today are only marginally better than taking sugar pills to treat one’s Depression. Therefore, the road to determining whether or not we are currently administering the proper medications for Major Depressive Disorders is up in the air for the future.
Nonetheless, in recent years there is an increasing body of literature specific to the elderly (as referenced below), which helps guide the clinician in the appropriate prescription and use of antidepressants in this patient population. For a list of commonly used antidepressants and associated doses for older adults, see the accompanying Table.
Identification followed by a thorough assessment can help guide the selection of an appropriate antidepressant medication. Selection of an antidepressant medication should be based on the best side effect profile and the lowest risk of drug-drug interaction. There are several factors to consider when selecting, adjusting, and changing antidepressants in the elderly. In cases of severe, psychotic, or refractory depression in the elderly, electroconvulsive therapy is recommended. Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness. The association of depression and mortality in elderly persons: A case for multiple, independent pathways.
National guidelines for seniors’ mental health: The assessment of suicide risk and prevention of suicide.
Development and validation of a geriatric depression screening scale: a preliminary report. Pharmacological and psychological treatments for depressed older patients: A meta-analysis and overview of recent findings.
Feasibility and effectiveness of treatments for depression in elderly medical inpatients: A systematic review.
Antidepressant pharmacotherapy in the treatment of depression in the very old: A randomized, placebo-controlled trial. Time to response for duloxetine 60 mg once daily versus placebo in elderly patients with major depressive disorder. Methylphenidate for the treatment of depressive symptoms, including fatigue and apathy, in medically ill older adults and terminally ill adults.
Efficacy and safety of adjunctive aripiprazole in major depressive disorder in older adult patients: A pooled subpopulation analysis. Placebo-controlled study of relapse prevention with risperidone augmentation in older patients with resistant depression.
Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. Risk of death with atypical antipsychotic drug treatment for dementia: Meta-analysis of randomized placebo-controlled trials.



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