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Dx Generalized Depression Treatment:


Summary: The consensus is that the five major classifications of antidepressant medications are equally effective. The ideal medication is individualized to maximize the benefits of the side-effects.
Atypical Antidepressant: Wellbutrin©XL/bupropion. Better choice for 1)smoker, 2)fatigue, 3)will not interfere with male sexual response.
SSRI: Prozac©/fluoxetine
SNRIs: Effexor©/venlafaxine
Tricyclic Antidepressant: Elavil/ amitriptiline. More sedation, mild weight gain. May be a consideration in young adult for short term adjustment disorder. Taken at bedtime.
MAO-inhibitor: limited to psychiatrists because of potential hypertensive crisis with exposure to tyrosine (wine, cheese), anticholingeric effects in the elderly.

Major Depression Disorders: Medication Choices Clinical Depression

The Merck Manual Home Edition states "The disorder depression is a feeling of sadness intense enough to interfere with functioning. It may follow a recent loss or other sad event but is out of proportion to that event and lasts beyond an appropriate length of time.
*Heredity, side effects of drugs, emotionally distressing events, imbalances in the body, and other factors can contribute to depression.
*Depression can make people sad and sluggish or anxious and fearful.
* Doctors base the diagnosis on symptoms.
*Antidepressants, psychotherapy, and sometimes electro-convulsive therapy can help.
*After anxiety, depression is the most common mental health disorder. About 30% of people who visit a primary care practitioner have symptoms of depression. However, only some of these people have major depression.
*People who become depressed typically do so in their mid teens, 20s, or 30s, although depression can begin at almost any age, including during childhood (see see Depression in Children). People born in the latter part of the 20th century seem to have higher rates of depression and suicide than those of previous generations, in part because rates of substance abuse have increased."

Medications Used in the Treatment:
1.  Benzodiazepines: Xanax®, Niravam®, Ativan®, Klonipin®, Valium®, etc.
2.  SSRIs: Zoloft®, Lexapro®, Paxil®
3.  Atypical antidepressants: Wellbutrin®
4.  Antihistamines: hydroxyzine hydrochloride, Vistaril®
5.  SNRIs: Effexor®XR, Cymbalta®
7.  Tricyclic Antidepressants: doxepin, maprotiline, amoxapine
8.  Azapirones: Buspar®/ buspirone
9.  Typical Antipsychotics: prochlorperazine, chlorpromazine, trifluoperazine
10. Typical Antipsychotic/ Triclylic Antidepressant Combinations: perphenazine/ amitriptyline

*[Editor] It has been recognized that Paxil®/flouroteine resistant depression was found in individuals with the lowest levels of B9 (folate) [7% vs. 44.7% responders]. Pamlabs, Inc. manufactures l-methyfolate under the tradename Deplin® at $4.00 for 7.5mg; Pure Encapsulation has a 5-L-methylfolate 1000mg for $0.12. There are no studies that state that taking 5-L-methylfolate will treat depression, but this and the other B vitamins are a requisition for good health and should be part of everyone's nutritional supplementation program.

*[Editor] The psychiatrist recognize that 'low mood' or dysthymia in older men responded very well to testosterone replacement in a double blinded study with the most stringent statistical evaluation (p<.006).

*[Editor] A number of natural vitamins, minerals and supplements are used internationally to treat depression/anxiety. While St. Johns Wart and 5-HTP have supports, no clear evidence is found in the literature. Those over-the-counter products that have raised the most interest and clinical proof are SAM-e and l-methylfolate.  Pregnenolone and Oxytocin may have potential: "in the brain, neurosteroids such as allopregnanolone and pregnenolone, acting as positive TSPO modulators of gamma-aminobutyric type A (GABA(A)) receptors, exert anxiolytic activity [block anxiety]... Unlike benzodiazepines (Bzs), which represent the most common anti-anxiety drugs administered around the world, selective TSPO ligands have shown anxiolytic effects in animal models without any of the side effects associated with Benzodiazipines. Therefore, ...[these]... may represent the future of therapeutic treatment of anxiety disorders. "See  Depression/ Anxiety- All Natural Products

*[Editor] Major medical university research studies have concluded that a Light Box and "light therapy had a specific antidepressant effect beyond its placebo effect, but it took at least 3 weeks for a significant effect to develop. The benefit of light over placebo was in producing more of the full remissions."

*[Editor] Screening for Laboratory tests may offer evidence that simple hormones may be out of balance. With these laboratory tests in hand, discuss them with your health care professional. Meta analysis for 7 studies showed a significant positive effect of testosterone therapy on Hamilton-Depression Scoring response in depressed patients when compared to placebo...greater response in subpopulation with hypogonadism (Low-T), and HIV/AIDs...The route by which testosterone therapy is administered may play a role in treatment response."

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