Antidepressant and Antimanic Medications: Indications for Use of Antidepressant and Antimanic Medications
Treatment should follow careful physical and psychological assessment and diagnosis. In most circumstances this process can be performed in one visit, especially if medically relevant history and psychiatric and substance abuse history are available. This process has recently been reviewed. Once a diagnosis of MDE has been made, antidepressant medications are usually indicated. Given the known efficacy and safety of these drugs, in most cases treatment should then be started, although the choice of agent may be significantly affected by presenting symptoms and concurrent psychiatric, medical, or substance abuse diagnoses.
Medication should be initiated as soon as possible for treatment of MDE in situations when improvement is unlikely without medication treatment, when possible harmful consequences may arise if the depression is untreated (e.g., loss of job or risk of suicide), or when relapse and recurrence are highly likely (
Table 39-3). Other situations in which medication treatment should be initiated include when treating patients with a strong family history of mood disorders or patients with MDE with atypical features.
Medication treatment should be postponed when the diagnosis of MDE is unclear, the symptoms are very mild, the risk of harmful consequences is minimal, or a patient feels strongly against the use of medication treatment. The most common of these situations occurs when a recent life stress raises the possibility that the symptoms represent a moderate to severe form of an adjustment disorder or when the depression may be secondary to medical illness or to concomitant medication or substance abuse. In these cases the decision to initiate medication treatment should follow one or two further evaluation meetings.
Antimanic medications are indicated for the treatment of mania or hypomania. Mania impairs judgment, often leading to serious legal or social consequences (e.g., financial loss, loss of an important relationship because of promiscuity). When symptoms of hypomania or mania are observed, treatment should be initiated. Hospitalization is usually necessary for mania, but hypomania often can be treated on an outpatient basis.
Because many medications, drugs of abuse, and neurological and medical conditions have been associated with mania, a careful psychiatric, general medical, and neurological history and physical examination are indicated. These procedures are even more important if the current episode is a first episode in a patient older than age 40. The drugs and conditions associated with mania are listed in
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: July 5, 2011
Last revised: by Andrew G. Epstein, M.D.