Posted by SalArmy4me on August 23, 2001, at 7:07:15
In reply to Effexor, feel nothing.. anyone experience this?, posted by cerose on August 22, 2001, at 21:40:57
Year Book of Psychiatry and Applied Mental Health
Volume 1999(8) Annual 1999 pp 366-367
Pharmacological Choices After One Antidepressant Fails: A Survey of UK Psychiatrists"Pharmacological Choices After One Antidepressant Fails: A Survey of UK Psychiatrists
Shergill SS, Katona CLE (Maudsley Hosp, London; UCL Med School, London); J Affect Disord 43:19-25, 1997
Introduction.-Approximately one third of patients with depression fail to respond to first-line antidepressants, and up to 21% have not recovered after 2 years of adequate dosage and compliance. A popular option in such cases is lithium augmentation, but it is not known whether most psychiatrists are aware of treatment choices for refractory depression. This question was examined in a survey of practicing psychiatrists in the United Kingdom.
Methods.-The survey, sent to 300 randomly selected physicians on the membership roll of the Royal College of Psychiatrists, presented a detailed vignette of a "typical" case of depression with initial treatment failure. The patient was a white woman, aged 40, who had been depressed for about 4 months. She sought treatment after intrusive suicidal thoughts led her to consider crashing her car. Her history included sexual abuse by her stepfather, migraine headaches, and a sister who had been treated for an episode of major depression. Treatment consisted of amitriptyline, 150 mg daily; and intensive individual, group, marital, and occupational therapy. No improvement was seen after 6 weeks.
Results.-Surveys were returned by 175 psychiatrists (63%). Respondents were predominantly men (61%) working as consultants (51%) in general psychiatric practice (62%). They had spent a mean of 13 years in the field and saw a mean of 9 patients per year with refractory depression. The most popular treatment choices in such cases were increasing dosages of tricyclic medication and change of medication to selective serotonin reuptake inhibitors; augmentation with tri-iodothyronine or with tryptophan or monoamine oxidase inhibitors was rarely chosen. Psychiatrists with elderly patients were more likely to choose lithium augmentation; electroconvulsive therapy was the preferred choice of those seeing more patients with resistant depression.
Conclusion.-The best established treatments for resistant depression were underused by psychiatrists in the United Kingdom, many of whom (39%) expressed a lack of confidence in treating this problem. Resistant depression should be included as a topic in continuing professional development courses.
[r tri, filled] In this survey of Fellows of the Royal College of Psychiatrists in the United Kingdom (all of whom would be considered well-trained, often-senior people) regarding their choice of treatment after initial antidepressant failure, almost half the respondents would have increased the dosage, and another third would have switched from the tricyclic antidepressant used as the initial treatment in the case vignette to a selective serotonin reuptake inhibitor. However, the findings that only 1% of respondents would potentiate with tri-iodothyronine and that only 12% would have chosen to augment with lithium were surprising. Although most of these psychiatrists had executed most of the treatment choices, a third of the respondents were not confident treating resistant depression. The need for information in this clinical area is clear. There are very few data by which to guide these treatment decisions, and unfortunately the literature is not always useful to the practicing clinician. The authors suggest that additional training and postgraduate education are important in enhancing the skills of psychiatrists-even the best-educated ones-in the management of this population."
R.B. Lydiard, Ph.D., M.D.
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