Special Aspects in the Treatment of Depressive Episodes in Mamc Depressive Disorder

Several special aspects that differentiate treatment of depressive episodes during manic-depressive disorder should be noted. First, lithium appears to be an effective antidepressant in depressive episodes during manic-depressive disorder (see Tables 4.5 and 4.9), whereas the evidence is equivocal for its efficacy in unipolar depression (Fieve, Platman, & I'lutchik, 1968; Goodwin et al, 1972).

Second, it should be kept in mind that all somatic antidepressant treatments are potentially pro-manic, with the probable exception of lithium. These two facts indicate that lithium should be the first-line treatment for unmedicated persons with manic-depressive disorder in the depressed phase.

TABLE 4.23







Hepatic Overdose toxicity

Citalopram +2

Third, although there are few data indicating that depression during manic-depressive disorder responds preferentially to any particular drug, there is evidence as noted above that persons with manic-depressive disorder who have hypersomnolent, anergic depressive episodes may respond to monoamine oxidase inhibitors better than to tricyclics (Himmelhoch, Thase, Mallinger, & Fuchs, 1991; Thase, Mallinger, McKnight, & Himmelhoch, 1992), In this regard, it should also be noted that ECT may be more effective than tricyclic

(reviewed in Zornberg & Pope, 1993). Thus, these modalities cannot be ignored as potential agents in treating manic-depressive disorder and should not be relegated to "last chance" status. Increasing education and comoni-toring during group psychotherapy can improve compliance and make MAOIs more practically useful and ECT more acceptable when indicated.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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