Antidepressant and Antimanic Medications: Diagnostic Indications and Contraindications
The terms antidepressant and antimanic imply selectivity and specificity to depression and mania, respectively. It is increasingly clear, however, that this is not the case. Not only are these medications effective in the short-term treatment of milder mood disorders such as dysthymia, but they are frequently effective in the treatment of other mental disorders such as generalized anxiety, panic disorder, social phobia, obsessive-compulsive disorder (OCD), bulimia and anorexia nervosa, posttraumatic stress disorder, and possibly alcohol abuse.
Experiments in laboratory animals have shown that antidepressant drugs primarily affect the core brain systems involved in modulating stress responses , and the disorders for which antidepressant drugs have been established to have efficacy are all conditions that can be exacerbated by stress (Chrousos and Gold 1992). These observations suggest that antidepressant drugs may simply restore function without altering the pathological state, an effect that can be seen as analogous to the nonspecific anti-inflammatory effects of corticosteroids in the treatment of various medical conditions.
Not all of the medications described in this chapter are approved by the U.S. Food and Drug Administration (FDA) for the treatment of a major depressive episode (MDE), major depressive disorder (one or more MDEs), or a manic episode. There are several cases in which published studies have shown efficacy, but formal FDA approval has not been sought. These include the use of d-amphetamine, buspirone, alprazolam, or combination/augmentation strategies in the treatment of MDEs, and the use of carbamazepine, valproic acid, or antipsychotic drugs in the treatment of mania. Although it is ethical and legal to use these medications for non-FDA-labeled uses, it is prudent to consider trials of FDA-approved drugs first, because these drugs have been studied the most.
For the purposes of this chapter, antidepressant drugs will be defined as those drugs for which efficacy has been shown in published clinical studies of the treatment of an MDE, and antimanic agents will be defined as those drugs for which efficacy has been shown in the treatment of a manic episode. MDE and manic episode are defined as in DSM-IV (American Psychiatric Association 1994). The diagnostic criteria for MDE and manic episode are presented in Tables39-1 and
Antidepressant and Antimanic Medications
Combined Medication and Psychotherapy
Treatment-Resistant Mood Disorders
Treatment of Mood Disorders in the Medically Ill Patient
Strategies and Tactics in the Treatment of Depression
Revision date: June 21, 2011
Last revised: by Andrew G. Epstein, M.D.