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Outpatient Management of Depression
Tables and Figures |
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TABLES
Table 1.1 Critical
Variables in Diagnosis 12
Table 1.2 DSM-IV
Diagnostic Criteria for a Major Depressive Episode 14
Table 1.3 Signs
and Symptoms of Different Types of Affective Episodes 16
Table 2.1 Unipolar
Depression in the United States 22
Table 2.2 The Hidden
Cost of Not Treating Major Depression 22
Table 2.3 Suicide
and Major Depression: The Rule of Seven 23
Table 2.4 Risk Factors
for Major Depression 25
Table 3.1 Typical
Behavior During Office Visit 34
Table 3.2 Varied
Terms Used for Depressed Mood 37
Table 4.1 Risk Factors
For Suicide: “SAD PERSONS” Scale 40
Table 4.2 Patient’s
Typical Questions About Major Depression 43
Table 5.1 What Is
“Response” and “Remission” in Major Depression?
53
Table 5.2 Predictors
of Placebo Response in “Depressed” Patients 53
Table 5.3 Factors
Related to Noncompliance 55
Table 6.1 Classification
of Antidepressants By Putative Mechanism(s) of Action Responsible
for Antidepressant Efficacy: Generic/(Trade) Names By Drug
Class 58
Table 6.2 Comparison
of the Mechanisms of Action of Antidepressants 62
Table 6.3 Sites
of Action and Clinical and Physiologic Consequences of Blockade
or Antagonism 66
Table 6.4 Comparison
of the Placebo-Subtracted Incidence Rate (%) of Frequent Adverse
Effects for Citalopram, Fluoxetine, Fluvoxamine, Paroxetine,
and Sertraline 68
Table 6.5 Comparison
of the Placebo-Subtracted Incidence Rate (%) of Frequent Adverse
Effects for Bupropion, Imipramine, Mirtazapine, Nefazodone,
and Venlafaxine 72
Table 6.6 The Most
Likely Specific Adverse Effects on Specific SSRIs Above and
Beyond the Parallel Placebo Condition (Percentage on Drug
Minus Percentage on Placebo Based on Registration Studies)
76
Table 6.7 The Most
Likely Specific Adverse Effects on Specific Antidepressants
Above and Beyond the Parallel Placebo Condition (Percentage
on Drug Minus Percentage on Placebo Based on Registration
Studies) 78
Table 6.8 Amitriptyline:
Polydrug Therapy in a Single Pill 83
Table 6.9 Effect
of Cytochrome P450 Enzymes on Specific Drugs (ie, Metabolism)
90
Table 6.10 The
Inhibitory Effect of Newer Antidepressants at Their Usually
Effective Minimum Dose on Specific CYP Enzymes 94
Table 6.11 Summary
of Formal In Vivo Studies of the Effects of Different SSRIs
on CYP 2D6 Model Substrates 96
Table 6.12 Symptoms
of Anticholinergic Withdrawal Syndrome 100
Table 6.13 Symptoms
of Serotonin Reuptake Inhibitor Withdrawal Syndrome 101
Table 7.1 STEPS
Criteria for Selecting an Antidepressant 106
Table 7.2 STEPS
Criteria for Mixed Reuptake and Neuroreceptor Antagonists
(eg, Amitriptyline) 107
Table 7.3 STEPS
Criteria for Norepinephrine Selective Reuptake Inhibitors
(eg, Desipramine) 108
Table 7.4 STEPS
Criteria for Serotonin Selective Reuptake Inhibitors (eg,
Sertraline) 109
Table 7.5 STEPS
Criteria for Serotonin and Norepinephrine Reuptake Inhibitors
(eg, Venlafaxine) 110
Table 7.6 STEPS
Criteria for Serotonin-2A Receptor Antagonist and Weak Serotonin
Reuptake Inhibitors (eg, Nefazodone) 111
Table 7.7 STEPS
Criteria for Serotonin (5-HT2A and 5-HT2C) and Norepinephrine
(a-2) Receptor Antagonists (eg, Mirtazapine) 112
Table 7.8 STEPS
Criteria for Dopamine and Norepinephrine Reuptake Inhibitors
(eg, Bupropion) 113
Table 7.9 STEPS
Criteria for Monoamine Oxidase Inhibitors (eg, Tranylcypromine)
114
Table 7.10 Average
Wholesale Price of Representative Doses of Antidepressants
126
Table 7.11 Summary
of Package Insert Dosing Guidelines 130
Table 8.1 Percentage
of New Prescriptions Written for Specific Antidepressants
During October, 1998 138
Table 8.2 Indications
Formally Labeled By the FDA for Specific Sertonin Selective
Reuptake Inhibitors 148
Table 10.1 Percentage
of Patients on Antidepressants Having the Potential to Experience
a Drug-Drug Interaction as a Function of Treatment Setting
180
Table 10.2 Prevalence
of Major Depression in Specific Medically Ill Populations
182
FIGURES
Figure 1.1 Diagnostic
Criteria Pyramid 12
Figure 3.1 Diagnostic
and Treatment Planning Process 30
Figure 6.1 Relative
Potency for Different Sites of Action for Three Different
Types of Antidepressants: Amitriptyline, Desipramine, and
Sertraline 81
Figure 6.2 In Vivo
Profile of SSRIs on SE Uptake Inhibition Versus CYP Enzyme
Inhibition 82
Figure 6.3 Relative
Potency for Different Sites of Action for the Various Members
of the SSRI Class of Antidepressants 85
Figure 6.4 Relative
Potency for Different Sites of Action for Non-SSRI Antidepressants:
Bupropion, Imipramine, Mirtazapine, Nefazodone, and Venlafaxine
86
Figure 6.5 How Knowledge
of CYP Enzymes Will Simplify Understanding of Pharmacokinetic
Interactions 99
Figure 9.1 Algorithm
for Treating Patient With Major Depression 175
Figure 9.2 Zung
Depression Self-Report Rating Scale 176
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