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Chapter 23. Antidepressant and Antimanic Medications

Andrew A. Nierenberg, M.D.; Michael J. Ostacher, M.D., M.P.H.; Pedro L. Delgado, M.D.; Gary S. Sachs, M.D.; Alan J. Gelenberg, M.D.; Jerrold F. Rosenbaum, M.D.; Maurizio Fava, M.D.
DOI: 10.1176/appi.books.9781585622986.255448

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Excerpt

Major depressive disorder and bipolar disorder are highly prevalent (Kessler et al. 2003, 2005) and are among the top 10 causes of disability worldwide (Murray and Lopez 1996). These mood disorders tend to be underrecognized and undertreated (Kessler et al. 2003; Wang et al. 2005), despite substantial evidence that supports the efficacy and effectiveness of pharmacological and psychotherapeutic interventions. In this chapter we critically review the available evidence for the efficacy and adverse effects of antidepressant and antimanic medications as well as evidence for the management of treatment-resistant mood disorders. To the greatest extent possible, only controlled trials of adequate size will be used to make treatment recommendations.

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Figure 23–1. Sites of antidepressant action.(1) blockade of neurotransmitter reuptake; (2) inhibition of monoamine oxidase (MAO); (3) release of neurotransmitter; (4) blockade or stimulation of receptors. 5-HT = 5-hydroxytryptamine (serotonin); 5-HIAA = 5-hydroxyindoleacetic acid.
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Table 23–1. Categories of antidepressant drugs
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Table 23–2. Pharmacokinetics of selective serotonin reuptake inhibitors
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Table 23–3. Clinical trials of augmentation strategies in unipolar depression
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Table 23–4. Clinical trials of switching strategies in unipolar depression

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