tailieunhanh - HANDBOOK OF PSYCHIATRIC DRUGS - PART 3

Việc sử dụng thuốc chống trầm cảm trong điều trị trầm cảm vẫn còn sử dụng được hiểu biết tốt nhất của các loại thuốc này, tuy nhiên, có một danh sách ngày càng tăng của các chỉ dẫn khác cho thuốc chống trầm cảm, bao gồm cả rối loạn hoảng sợ (PD), rối loạn ám ảnh cưỡng chế (OCD), ăn vô độ và posttraumatic rối loạn stress | 2 ANTIDEPRESSANTS INTRODUCTION The use of antidepressants in the treatment of depression remains the best-understood use of these medications however there is a growing list of other indications for antidepressants including panic disorder PD obsessive-compulsive disorder OCD bulimia and posttraumatic stress disorder PTSD . Many of these illnesses respond best to combination treatment modalities that include medication and various forms of psychotherapy. PHARMACOLOGY The first antidepressant was the monoamine oxidase inhibitor MAOI iproniazid initially licensed as an antituberculosis drug. This was soon followed by the tricyclic antidepressant TCA imipramine. Although both were developed in the early 1950s they represented different paths of discovery iproniazid was the result of clinical and laboratory collaboration whereas imipramine s introduction was largely based on clinical observation. Within the past 25 years similarly efficacious tricyclic and heterocyclic antidepressants have been developed but with varying side-effect profiles. A new direction in antidepressant pharmacology began in 1987 with the discovery and Handbook of Psychiatric Drugs Jeffrey A. Lieberman and Allan Tasman 2006 John Wiley Sons Ltd. ISBN 0-470-02821-1 42 HANDBOOK OF PSYCHIATRIC DRUGS marketing of fluoxetine the first antidepressant selective for serotonin reuptake blockade. Beyond selective serotonin reuptake inhibitors SSRIs the latest offerings in antidepressant pharmacology include agents that act at multiple neurotransmitter levels. In evaluations of the many antidepressants available the focus has generally been on the agent s side-effect profile and ease of administration. Despite many efforts in this area there is no conclusive evidence to demonstrate the clinical superiority of any one group of agents. Mechanisms of Action All known antidepressants affect monoamine neurotransmission. MAOIs inhibit the activity of monoamine oxidase resulting in a decrease in the breakdown of .