Book contents
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- 1 Melancholia: a conceptual history
- 2 Melancholia defined
- 3 Defining melancholia by psychopathology
- 4 Defining melancholia: laboratory tests
- 5 Examination for melancholia
- 6 The differential diagnosis of melancholia
- 7 Suicide in melancholia
- 8 Electroconvulsive therapy for melancholia
- 9 Achieving effective ECT
- 10 The validity of the pharmacotherapy literature in melancholia
- 11 Basic pharmacotherapy for melancholic patients
- 12 Pharmacotherapy for melancholic patients in complicating circumstances
- 13 Proposed treatments for melancholia
- 14 The pathophysiology of melancholia
- 15 Future directions
- References
- Index
11 - Basic pharmacotherapy for melancholic patients
Published online by Cambridge University Press: 14 August 2009
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- 1 Melancholia: a conceptual history
- 2 Melancholia defined
- 3 Defining melancholia by psychopathology
- 4 Defining melancholia: laboratory tests
- 5 Examination for melancholia
- 6 The differential diagnosis of melancholia
- 7 Suicide in melancholia
- 8 Electroconvulsive therapy for melancholia
- 9 Achieving effective ECT
- 10 The validity of the pharmacotherapy literature in melancholia
- 11 Basic pharmacotherapy for melancholic patients
- 12 Pharmacotherapy for melancholic patients in complicating circumstances
- 13 Proposed treatments for melancholia
- 14 The pathophysiology of melancholia
- 15 Future directions
- References
- Index
Summary
I, who have always seen him so serene, so completely the master of his wonderful emotional instrument … so sensitive to human contacts and yet so secure from them; I could hardly believe it was the same James who cried out to me his fear, his despair, his craving for the “cessation of consciousness,” and all his unspeakable loneliness and need of comfort, and inability to be comforted! “Not to wake – not to wake –” that was his refrain; “and then one does wake, and one looks again into the blackness of life, and everything ministers to it.”
Among the interventions for the relief of melancholia, electroconvulsive therapy (ECT) is the most effective and should be considered in the treatment of every melancholic patient. Although superior to medications in the treatment of depressive illness, ECT is intrusive, not widely available, and most psychiatrists are not trained to prescribe or administer it. ECT has been so stigmatized that it is widely considered the treatment of last resort. The cost per treatment is substantial. The efficacy and optimal use of ECT are discussed in Chapters 8 and 9.
Melancholia is an illness that requires acute treatment to resolve the episode of depression, continuation treatment to preserve the remission and prevent relapse, and long-term treatment to reduce the risk of recurrence.
The basic pharmacotherapy for adult melancholic patients in uncomplicated circumstances warrants simplified algorithms.
- Type
- Chapter
- Information
- MelancholiaThe Diagnosis, Pathophysiology and Treatment of Depressive Illness, pp. 211 - 238Publisher: Cambridge University PressPrint publication year: 2006