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AN ATLAS OF DEPRESSION - PART 4

Phân tích phân nhóm của các cơ sở dữ liệu thử nghiệm lâm sàng Chỉ Đó IS moclobemide hiệu quả trong điều trị ngắn hạn của các đơn cực, lưỡng cực, "nội sinh" và "phản ứng" depression4. Trong một số nước moclobemide ĐÃ giấy phép cho điều trị ám ảnh xã hội (xã hội rối loạn lo âu) | fluvoxamine3. Subgroup analysis of the clinical trial database indicates that moclobemide is efficacious in the short-term treatment of unipolar bipolar endogenous and reactive depression4. In some countries moclobe-mide has a license for the treatment of social phobia social anxiety disorder 5 6 although only two out of four randomized controlled trials found it to be significantly more effective than placebo7. Studies in healthy volunteers have shown that shortterm treatment with high doses of moclobemide 900 1200 mg day can produce an exaggerated tyra-mine pressor response and that a standard dose 300 mg twice-daily can potentiate the effects of ephedrine on heart rate and blood pressure8 9. For these reasons there should be caution when coprescribing potentially interacting medications. Patients should be advised to avoid consuming large amounts of tyramine-rich foodstuffs. Moclobemide has a low incidence of sexual dysfunction. SELECTIVE SEROTONIN REUPTAKE INHIBITORS Examples of the SSRIs in common use are fluoxetine fluvoxamine paroxetine sertraline citalopram and esci-talopram Figure 9.13 . Compared to TCAs and MAOIs SSRIs are somewhat better tolerated and relatively safer but treatment-emergent insomnia and sexual dysfunction are common problems. In United Kingdom primary care the most commonly prescribed antidepressants are the TCAs including the older drugs amitriptyline and dothiepin and the newer TCA lofepramine and SSRIs. Systematic reviews and meta-analyses suggest that the different classes of antidepressant drugs have comparable overall efficacy1 10-12. SSRIs appear marginally less effective than TCAs in hospitalized patients with major depression but they have similar efficacy to tricyclic drugs in the majority of patients seen in primary care or outpatient set-tmgs1 10-12. Advantages and disadvantages of SSRIs SSRIs have a number of advantages in the treatment of depression and the associated disorders broad-spectrum efficacy depression panic .