Depression and Psychopharmacology

Statistics shows that in the modern world non-psychotic illnesses are met very often. They are significantly more widespread than psychotic disorders and bring suffering and death. Common misunderstanding of mental illnesses and the established contemptuous attitude of people and doctors represent main obstacles to the successful cure of mentally ill people. Recently, the progress of psychiatric investigation threw the light on the occurrence, reasons, cure, and consequences of different mental illnesses. Depression is one of them.

It was determined that depression, especially its serious cases, really needs psychopharmacological interference (Murray, Lopez , 1996). Thorough investigations are currently held in order to find new medicines to help people suffering from depression. The given paper will discuss the new antidepressants in comparison to old and explain their advantages. The ways of depression treatment Two main ways to treat depression were defined: psychoanalysis and psychopharmacology. Psychoanalysis is an approach proposed by Freud that implies regular conversation with psychotherapist about ideas and feelings a sick person has.

This approach is widely used in developed countries where visits to psychotherapist are usual and included in everyday life of many people (Murray, Lopez , 1996). Psychopharmacology represents a mix of psychotherapy and medications and currently used for more serious cases of depression. Psychiatrists who use psychopharmacology suppose that the main problem of their patient is in his/her brain and only medicines can help change brain processes, while psychotherapy is not enough (Murray, Lopez 4). The advantages and disadvantages of new antidepressants

Antidepressants were unexpectedly invented at the beginning of the twentieth century. Before, the most widely applied antidepressants were tricyclic antidepressants (TCAs) as the most popular, and monoamine oxidase inhibitors (MAOIs) (Settle EC. , 1998). However, around twenty years ago, new antidepressants were created for treatment of depression. The creation of selective serotonin re-uptake inhibitors (SSRIs) and their application as newly developed medicine for depression shows that the improvement of antigepressants changed from unexpected invention to rational and thought-over mechanism.

The investigations in this field advanced doctors’ and researchers’ understanding of the fundamentals of mental illnesses and application of medicines for them. Anderson (1998) stated: In parallel with the development of new antidepressants, there has been a rapid advancement of neuro science and a greatly enhanced understanding of the various subtypes of 5HT and NA receptors. Seven major subtypes of serotonin receptor have been cloned so far. They differ in terms of pharmacological property, signal transduction mechanism, and gene sequence.

The 5HT receptor is both a somatic autoceptor that controls the firing rate of 5HT neurons and a postsynaptic receptor. It thus closely governs mood regulation (p. 2). The most important gain of new medicines is their security in case of overdose. The recently developed drugs are more and more recommended in preference to the usual TCAs. A good reason for this application is the danger of lawful and medical consequence after TCAs’ application while more secure substitute medicines are obtainable (Hirschfeld RM, Keller MB, Panico S, et al. , 1997).

Various tests and investigations testified that the new medicines have an analogous effectiveness to TCAs. Nevertheless, debates take place over the question if the new drugs, mainly SSRIs, have a worse effect. Song F, Freemantle N, Sheldon TA, et al (1993) stated: Whether SSRIs can work as effectively as TCAs in treating severe depression is also controversial. In a recent meta-analysis comparing 25 studies of SSRIs and TCAs that were used to treat depressed in-patients, the dual-action TCAs were found to have superior efficacy but were more poorly tolerated than SSRIs (p. 24).

Before, the investigations did not show any advantages of SSRIs over old and tested TCAs. Further thorough investigation showed that the effect of SSRIs is really weaker but not significantly. However, in spite of the risk of self-murder, many people still choose the TCAs. Duration of Psychopharmacologic treatment The duration of depression is usually recurring and continual, so psychopharmacologic treatment usually includes three phases: the preliminary heightened period, the persistence period, and the effect-keeping phase that prevent the return of illness. The first and second phases are normally held for three months each.

Treatment maintenance is very important for recurring illnesses. Its duration is dependent on many factors and can’t be exactly determined without careful examination of the case. Not every patient is at risk of illness recurring, thus treatment duration varies from 6-9 months to 4-5 years. The dosage of medicine for efficient effect maintenance is usually the same as during the first two stages of treatment. Also the effect is dependent of antidepressant chosen. Saxena PR. (1995) wrote: …. future drug development should aim at producing antidepressants that work faster.

Preliminary evidence suggests that targeting subtype receptors—for example, by using a combination of a blocker of the 5HT autoceptor such as pindolol, and an SSRI—may accelerate the antidepressant response (p. 15). This again testifies that newly developed antidepressants can decrease the duration of treatment and help disprove the rather widespread opinion that mental diseases are incurable. The cost of treatment With the development of medical care financial plans which need high expenses, significant attention must be paid to the cost-effective assessment of medicines for depression treatment.

At the same time as further investigation of this significant issue is still necessary, researches approved new antidepressants as improving the state of the patients and bringing them to normal life. The application of old medicines instead of SSRIs only because they are not so expensive is not supported by medicine, because at the same time as the SSRIs costs more it is proved that patients finally spend less money due to their better effect and no dependence. TCA medicines can have side effects that generate many complications.

Consequently a patient has to visit his doctor more often that results in additional costs. Conclusion The popularity of psychopharmacologic treatment of depression with newly-developed and secure medicines is growing. Notwithstanding that TCAs are still applied, particularly for serious cases of illness, high risk of applying TCA treatment in people who are inclined to self-murder, as well as improvement of rights and opportunities of the patients completely change the model of antidepressant application (Settle EC. , 1998).

For many countries it is necessary to estimate the cost- efficiency of newly developed medicines in comparison to the medicines applied before, taking into account the cost of the whole process of treatment with all possible side effects and complications (Desjarlais R, Eisenber L, Good B, et al. 38). If the authorities do not pay proper attention to the serious danger of mental illnesses – especially depression as it is met very often in the modern society—a difficult situation in the field of psychopharmacological therapy will exist.

Bibliography Anderson IM. (1998). SSRI versus tricyclic antidepressants in depressed in-patients: a meta analysis of efficacy and tolerability. Oxford: Oxford University Press; Desjarlais R, Eisenber L, Good B, et al. (1995). World Mental Health: Problems and priorities in low income countries. Keller MB, Lavori PW, Mueller TI, et al. (1992). Time to recovery, chronicity, and levels of psychopathology in major depression: A 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry Hirschfeld RM, Keller MB, Panico S, et al. (1997).

The national depressive and Manic depressive association consensus statement on the undertreatment of depression. JAMA Murray CJ, Lopez AD. (1996). The global burden of disease. Geneva, Switzerland: WHO Saxena PR. (1995). Serotonin receptors: subtypes, functional responses and therapeutic relevance. Pharmacol Ther; Settle EC. (1998). Antidepressant drugs: disturbing and potentially dangerous adverse effects. J Clin Psychiatry; Song F, Freemantle N, Sheldon TA, et al. (1993). Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. BMJ

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