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10.02.2015

Treatment options for depression, hissing ears constant - Try Out

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Strategies for augmenting and combining medication for patients with treatment-resistant depression (TRD). True TRD is usually defined, however, as a much smaller percentage of patients in whom contributory factors to treatment failure have been ruled out. Adequate antidepressant drug therapy for a major depressive episode has been well-defined in the clinical literature and in several national treatment guidelines. Antidepressant response traditionally has been defined as a 50% reduction from baseline in depression rating scales. Treatment options for the nonresponding patient with an accurate diagnosis of major depression uncomplicated by other psychiatric and medical conditions include optimizing the existing antidepressant therapy, augmenting therapy or switching therapy. For the many patients who receive an inadequate dose or duration of therapy, all attempts should be directed to optimizing their ongoing therapy. For the remaining patients with true TRD, treatment options include a number of possible augmentation strategies or switching therapy.
Buspirone is fairly well tolerated; side effects such as lightheadedness and nausea usually occur early in treatment and are usually transient.
Adults are not the only ones affected, young children may become a victim to depression as well. This charts explains a few treatment options for depression with amount of people who used it and how effective it was. Back to school: Back to bullying prevention for schools and parentsAs students prepare to return to school in the next few weeks, the one thing many are not looking forward to is being bullied.


Stimmel is professor of clinical pharmacy and psychiatry for the Schools of Pharmacy and Medicine at University of Southern California (USC). Myong is a lecturer and resident in psychiatric pharmacy practice for the School of Pharmacy at USC.
Patients are treatment-refractory only because they have been labeled as such by their clinician, even though most patients have the potential to respond to treatment (Guscott and Grof, 1991). The following discussion of augmentation and switching strategies is appropriate only for patients with true TRD. At least eight weeks at a full therapeutic dose is necessary to evaluate the efficacy of an antidepressant (O'Reardon and Amsterdam, 2001), and treatment must continue for an additional four to five months (American Psychiatric Association, 2000). Adverse effects, partial response, noncompliance and unrealistic patient expectations may all contribute to the lack of treatment success and must be addressed. The addition of liothyronine (Cytomel), a synthetic form of the natural thyroid hormone triiodothyronine (T3), to an existing regimen also has been studied as an augmentation strategy (Joffe et al., 1993). The current standard in treating major depression is defined as full remission of symptoms and restoration of functioning (Nierenberg and Wright, 1999).
The next step is to identify "pseudo-resistance," in which the patient, for whatever reason, did not have an adequate antidepressant trial. Unfortunately, many patients with major depression do not receive an adequate course of therapy. For many patients, however, a 50% reduction in symptoms means they will continue to have significant residual symptoms.


Fava (2001) reported that 11 double-blind, controlled trials of lithium augmentation in depression have been published; of those, 10 reported the observed response rate, which averaged 52% for a total of 135 lithium-treated patients. Similarly, among patients with buspirone augmentation of clomipramine (Anafranil) treatment, 63% showed complete or partial remission. Thus, it could be argued that most patients treated for an acute depressive episode are treatment-resistant since most do not achieve full remission of symptoms with the first somatic or psychosocial treatment they receive (Sackeim, 2001). The new standard of practice in the treatment of major depression is to treat to full remission of symptoms (Nierenberg and Wright, 1999). Buspirone is believed to aid in the alleviation of depressive symptomatology by enhancing net 5-HT1A-mediated synaptic activity via desensitization of presynaptic 5-HT1A receptors and down-regulation of postsynaptic 5-HT2 receptors.
However, the study investigators noted that the study results may be inconclusive due to the unusually high placebo response and that 69.4% of patients responded in a follow-up of open SSRI plus buspirone treatment.
They are based primarily upon theoretical advantages of multiple mechanism approaches to achieve remission of depressive symptoms.



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