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
10 - The validity of the pharmacotherapy literature in melancholia
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
… my few hours of sleep were usually terminated at three or four in the morning, when I stared up into yawning darkness, wondering and writhing at the devastation taking place in my mind and awaiting the dawn, which usually permitted me a feverish, dreamless nap
Melancholia is a severely debilitating illness with a high death rate and high potential for suicide. Its consequences were so dire that the introduction of even so intrusive a treatment as induced seizures was hailed as a remarkable advance. Over the past half-century, medications effective in ameliorating melancholia were developed and the fears that melancholia engendered in earlier centuries lessened.
Our present therapeutic ideal is to select treatments based on scientific study, defined as evidence-based medicine. Randomized controlled clinical trials form the foundation of evidence-based medicine, and the literature assessing the benefits of antidepressant and mood-stabilizing drugs is widely accepted. Reviews of this evidence conclude that all antidepressant medications have equal efficacy for major depression, differing only in side-effects. These conclusions influence clinical guidelines.
Present teaching, as expressed by an expert National Institutes of Mental Health (NIMH) panel states that: “The SSRIs [selective serotonin reuptake inhibitors] are clearly the drug treatment of choice for all forms of depression in the United States … These drugs are approximately equivalent to each other and to TCAs [tricyclic antidepressants] in efficacy … The SSRIs have a much more benign side effect profile than TCAs and, largely for this reason, have replaced TCAs as first line therapy.”
- Type
- Chapter
- Information
- MelancholiaThe Diagnosis, Pathophysiology and Treatment of Depressive Illness, pp. 196 - 210Publisher: Cambridge University PressPrint publication year: 2006