Depression Information
Depression, one of the most commonly diagnosed psychiatric disorders, is being diagnosed in increasing numbers in various segments of the population worldwide. Depression in the United States alone affects 17.6 million Americans each year or 1 in 6 people. Depressed patients are at increased risk of type 2 diabetes, cardiovascular disease and suicide. Within the next twenty years depression is expected to become the second leading cause of disability worldwide and the leading cause in high-income nations, including the United States. In approximately 75% of completed suicides the individuals had seen a physician within the prior year before their death, 45%-66% within the prior month. Approximately 33% - 41% of those who completed suicide had contact with mental health services in the prior year, 20% within the prior month.
There are many psychiatric and medical conditions that may mimic some or all of the symptoms of depression, or may occur comorbid to it. A disorder either psychiatric or medical that shares symptoms and characteristics of another disorder, and may be the true cause of the presenting symptoms is known as a differential diagnosis.
Many psychiatric disorders such as depression are diagnosed by allied health professionals with little or no medical training, and are made on the basis of presenting symptoms without proper consideration of the underlying cause, adequate screening of differential diagnoses is often not conducted. According to one study "non-medical mental health care providers may be at increased risk of not recognizing masked medical illnesses in their patients."
Misdiagnosis or missed diagnoses may lead to lack of treatment or ineffective and potentially harmful treatment which may worsen the underlying causative disorder. A conservative estimate is that 10% of all psychological symptoms may be due to medical reasons, with the results of one study suggesting that about 50% of individuals with a serious mental illness "have general medical conditions that are largely undiagnosed and untreated and may cause or exacerbate psychiatric symptoms."
In a case of misdiagnosed depression recounted in Newsweek, a writer received treatment for depression for years; during the last 10 years of her depression the symptoms worsened, resulting in multiple suicide attempts and psychiatric hospitalizations. When an MRI finally was performed it showed the presence of a tumor. She was however told by a neurologist that it was benign. After a worsening of symptoms, upon the second opinion of another neurologist, the tumor was removed. After the surgery she no longer suffered from "depression".
Medication
Various medications have been suspected of a having a causal relation in the development of depression; this has been classified as "organic mood syndrome". Some classes of medication such as those used to treat hypertension, have been recognized for decades as having a definitive relationship with the development of depression.
Monitoring of those taking medications which have shown a relationship with depression is often indicated, as well as the necessity of factoring in the use of such medications in the diagnostic process.
Topical Tretinoin (Retin-A); derived from Vitamin A and used for various medical conditions such as in topical solutions used to treat acne vulgaris. Although applied externally to the skin, it may enter the bloodstream and cross the blood brain barrier where it may have neurotoxic effects.
Interferons; proteins produced by the human body, three types have been identified alpha, beta and gamma. Synthetic versions are utilized in various medications used to treat different medical conditions such as the use of interferon-alpha in cancer treatment and hepatitis C treatment. All three classes of interferons may cause depression and suicidal ideation.
Depression Medication Information
Bupropion
Bupropion (marketed as Wellbutrin, Zyban, Voxra, Budeprion, or Aplenzin; and formerly known as amfebutamone) is an atypical antidepressant and smoking cessation aid. Its chemical name is β-Keto-3-chloro-N-tert-butylamphetamine, a substituted cathinone (β-Ketoamphetamine), both of which are chemical derivatives of substituted amphetamine. The drug therefore is a mild psychostimulant. Its primary pharmacological action is thought to be norepinephrine-dopamine reuptake inhibition. It binds selectively to the dopamine transporter, but its behavioural effects have often been attributed to its inhibition of norepinephrine reuptake. It also acts as a nicotinic acetylcholine receptor antagonist. Bupropion belongs to the chemical class of aminoketones and is similar in structure to stimulants cathinone and diethylpropion, and to phenethylamines in general. Medically, bupropion serves as a non-tricyclic antidepressant fundamentally different to most commonly prescribed antidepressants such as SSRIs.
Initially researched and marketed as an antidepressant, bupropion was subsequently found to be effective as a smoking cessation aid. With over 20 million retail prescriptions in 2007, it was the fourth-most prescribed antidepressant in the United States retail market after sertraline, escitalopram, and fluoxetine.
Bupropion lowers seizure threshold, and its potential to cause seizures has been widely publicized. However, at the recommended dose the risk of seizures is comparable to that observed for other antidepressants. Bupropion is an effective antidepressant on its own but it is particularly popular as an add-on medication in the cases of incomplete response to the first-line selective serotonin reuptake inhibitor (SSRI) antidepressant. In contrast to many other antidepressants, bupropion does not cause weight gain or sexual dysfunction; in fact, in most studies, groups placed on bupropion showed statistically significant increases in libido, and mild to moderate weight loss.
Citalopram
Citalopram ( brand names: Celexa, Cipramil) is an antidepressant drug of the selective serotonin reuptake inhibitor (SSRI) class. It has U.S. Food and Drug Administration (FDA) approval to treat major depression, and is prescribed off-label for a number of anxiety conditions.
Citalopram is typically taken in one dose, either in the morning or evening. Citalopram can be taken with or without food. The absorption of citalopram does not increase when taken with food, but can help prevent against nausea. Nausea is often caused when the 5HT3 receptors actively absorbs free serotonin, as this receptor is present within the digestive tract. The 5HT3 receptors stimulate vomiting. This side effect, if present, should subside as the body adjusts to the medication.
Citalopram is considered safe and well-tolerated in the therapeutic dose range. Distinct from some other agents in its class, citalopram exhibits linear pharmacokinetics and minimal drug interaction potential, making it a better choice for the elderly or comorbid patients.
