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Major depression, which is an aphasic and multifactorial disorder, has become widespread. This disorders lifetime prevalence is currently at 16%, with females more affected than males (Duval et al. 191). The disease involves exposure to stressful and traumatic events, biological susceptibility, predisposing temperament, and personality traits. This article examines the effectiveness of different depression treatments and reviews the therapeutic strategies, which can be helpful if the initial treatment fails.
One of the current acute treatments of depression is the use of antidepressants. According to Duval et al., it is vital to consider the patients personal preferences and medical condition to choose the most appropriate antidepressant treatment (197). For instance, the non-severely depressed patients may benefit from non-biological approaches, while the severe ones will need antidepressant drug therapy. For this treatment option to be effective, a specific process needs to be followed, which should involve patient participation. The patient is first educated on the nature of the proposed treatment option and the illness in general. For moderate depression, it is recommended that the decision to prescribe antidepressants is thought over for some time. However, a severely depressed patient should start using antidepressants immediately because therapy alone is not enough to trigger the neurobiological substrate. The response to antidepressants depends on the patients biological state and clinical features. This treatment option has different tolerability and therapeutic responses among various patients depending on their type of symptomology. Therefore, it is essential to determine the right antidepressant drugs to predict the outcome of the treatment.
The second treatment for depression is the use of selective serotonin reuptake inhibitors (SSRIs), such as sertraline, paroxetine, fluvoxamine, fluoxetine, and citalopram. According to Duval et al., SSRIs are more effective than primarily noradrenergic antidepressants when it comes to the reduction of anxiety and irritability symptoms (199). However, research has observed a more effective therapeutic response to noradrenergic antidepressants among severely depressed patients with psychomotor retardation than SSRIs because they cause fewer bothersome side effects. On the contrary, some studies have suggested that out-patients with atypical depression benefit more from monoamine oxidase inhibitors (MAOIs) (Duval et al. 199). However, MAOIs are secondary treatments because of the many interactions with other drugs and need much dietary restriction. For these reasons, SSRIs are only effective for patients who are mildly and moderately depressed, while tricyclic antidepressants (TCAs) are safer for severely depressed ones and be more effective (Duval et al. 199). Therefore, before administering selective serotonin reuptake inhibitors, it is necessary to consider the clients level of severity of the illness.
However, in severe depression, the effectiveness of TCAs depends on the administered dose. It has been found that a 75 mg/day dose is less effective than 150 mg/day (Duval et al. 199). However, this treatment is administered below the recommended doses because of anticholinergic adverse effects, including confusion, impaired concentration, blurred vision, constipation, and dry mouth, to minimize these impacts. On the contrary, the tolerability of SSRIs is better than TCAs, which explains why the former is safer even in overdoses (Duval et al. 199). Some of the adverse effects associated with SSRIs include anorexia, insomnia, sexual dysfunction, agitation, anxiety, nausea, and diarrhea. Therefore, the administered dosage is essential in determining the right treatment type, but it is crucial to consider the side effects.
When a depressed patient does not respond well to the first-choice treatment, three options trigger the response: switching to another antidepressant, increasing the initial antidepressant dose, and combining several drugs. When the initial treatment fails, it is advisable to choose another drug, preferably with a broader mechanism of action. However, Duval et al. suggest that before switching to the new treatment, it is recommended that the patient has a drug-free interval to prevent adverse drug-drug interactions (199). Another logical step is to increase the dosage of the initial antidepressant drugs. The compliance and metabolite states of the patient can be determined by checking the ratio of the parent compound and plasma concentrations of the antidepressant drugs. Increasing the dosage of SSRIs from 75 to 150 mg/day is effective, but it has some adverse effects, which have been mentioned above. The third option is to combine several drugs, such as lithium, tri-iodothyronine, with antidepressant therapy while being careful to avoid adverse interactions.
In conclusion, major depression has become very prevalent in recent years. This article discussed the various treatments of depression, considering their effectiveness and available options if the first-choice therapy fails. Some of the current treatments for this disorder are selective serotonin reuptake inhibitors and tricyclic antidepressants. These approaches to treating depression depend on the mechanism of actions of the drugs, the pathophysiology and genetics, and the patients therapeutic responses. Sometimes, the depressive symptoms fail to disappear after the first treatment, which calls for another option, such as switching to other depressants, increasing the dosage, or combining several drugs. While choosing any of these alternatives, it is essential to consider the adverse effects, the severity of the depression, and drug-drug interactions to determine the best choice.
Work Cited
Duval, Fabrice, et al. Treatments in Depression. Dialogues in Clinical Neuroscience, vol. 8, no. 2, 2006, pp. 191-206.
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