Tuesday, November 13, 2007

Pharmacological Management of Major Depressive Disorder

About 121 million people worldwide suffer from depression. Major depression is one of the main causes of disability adjusted life years (DALY) as measured by the global burden of disease.1 The lifetime risk of major depression is about 15% for men and about 30% for women.2 Numerous types of depression exist, such as melancholic, atypical, psychotic, postpartum, bipolar, resistant, and mixed depression.3 The most commonly encountered types of depression and specific recommendations for their pharmacologic management are discussed below.
Many medications are used for the management of major depression. These include tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), second generation atypical antidepressants (eg, bupropion, mirtazapine), psychostimulants (eg, methylphenidate), mood stabilizers (eg, lithium), and augmentation drugs (eg, triiodothyronine). Antidepressants work through a variety of mechanisms, a topic beyond the scope of this newsletter, but generally influence the function of neurotrasmitters such as norepinephrine, serotonin, or dopamine by exerting an impact on the interaction of these neurotransmitters with their receptors.

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