An atlas of depression by David S Baldwin; Jon Birtwistle

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By David S Baldwin; Jon Birtwistle

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However, the use is advocated for those with bereavement-related depression and anxiety, and traumatic grief. The SSRIs have a number of advantages as the choice of therapy for bereavement-related depression, as they have a broad spectrum of efficacy in the treatment of depressive disorders and anxiety disorders (panic disorder, OCD, social phobia and post-traumatic stress disorder) that are seen in bereavement. In addition they are relatively safe in overdose. Unlike TCAs, SSRIs have no ©2002 CRC Press LLC carditoxicity in overdose, and the increased risk of death from cardiovascular disease within the first 6 months of bereavement is an important variable to consider.

Unfortunately, it may precipitate seizures in patients predisposed to epilepsy and has a high incidence of seizures at doses above 200 mg. Therefore a maximum dose of 150 mg has been recommended. Like other TCAs it is potentially cardiotoxic in overdose. 34. A long-term study found a higher rate of suicide attempts with maprotiline than with placebo48. 35). It has a weak inhibitory effect on norepinephrine reuptake and is a potent antagonist at a number of 5-HT receptor subtypes (particularly 5-HT2A and 5-HT2C receptors).

Comparative data are available for only the SSRIs, where paroxetine appears most likely, and fluoxetine least likely to be associated with discontinuation reactions1. Discontinuation symptoms appear less likely in shorter courses of treatment and if the drug dosage is tapered, but controlled evidence for tapering treatment is lacking. The March 2000 edition of the British National Formulary (BNF) states that abrupt withdrawal of an SSRI should be avoided. There is no consensus on the pharmacologic management of established SSRI discontinuation syndrome, but the results of a controlled study with SSRIs show that reinstatement of the original drug may relieve symptoms.

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