Medicus, Vol. 13 No. 1_Depresija, 2004.
Review article
The Rational Use of Antidepressants: Treating the Whole Patient
Miro Jakovljević
Abstract
Although antidepressants as a class have
been available for over 45 years we have still have lots of gaps
in our knowledge about their therapeutic mechanisms. Antidepressants
should be prescribed for any of the three phases of
treatment of depression or anxiety disorders described as
acute, maintenance and prophylactic treatment. The goal of
acute treatment (first several weeks) is to eliminate or alleviate
the symptoms of an active depressive episode. The goal of
maintenance treatment is to prevent a relapse into the index
episode after the alleviation of symptoms during at least six
months. The goal of prophylactic treatment is to prevent the
future reoccurrence of new depressive episodes. Differences in
the selectivity and intensity of inhibition of monoamine neuronal
reuptake transporters as well as in affinities for various neurotransmitter
receptors may explain the differences in clinical efficacy,
effectiveness, efficiency and side-effect profiles of the
available antidepressants. In spite of broad similarities in their
biological mechanisms of action, selective serotonin reuptake
inhibitors (SSRIs) are a heterogenous medication class. Serotonin
transporter inhibition is the common mechanism of action
of all SSRIs (fluvoxamine, fluoxetine, sertraline, paroxetine,
citalopram, escitalopram) and probably responsible for what
these different medications have in common. Differences in
binding properties to other neuroreceptor and subreceptor sites
as well as in the degree of inhibition of cytochrome enzymes
more likely account for the clinical differences observed
between different SSRIs in efficacy, side-effect profiles and drug
interactions. It is the same case with selective noradrenaline
reuptake inhibitors (maprotiline, reboxetine) and some other
antidepressant classes. Clinicians should be aware of advantages,
limitations, and problems of algorithms and use ”individualized
antidepressant medication” approach for improved
treatment efficacy with fewer adverse effects (higher effectiveness)
and better cost-benefit ratio (higher efficiency).
Keywords
antidepressants; rational use; phases of treatment; efficacy; effectiveness; efficiency
Hrčak ID:
19804
URI
Publication date:
26.1.2004.
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