Depressive illness does not always require treatment with somatic therapy ST. Only patients with "endogenous" or a "melancholic" depression need somatic therapy. They usually respond better to ST than
patients suffering from "reactive" or "nonmelancholic" depression.To identify an endogenous depression, psychiatrists examine the patient's symptoms. Patients with a medication-responsive depression tend to have many "vegetative" or physical symptoms, such as insomnia, loss of appetite, weight loss, diminished sex drive. Specific aspects of the patient's change in mood are important. If the mood is "nonreactive," so that the person is unable to brighten up when something pleasant occurs, this is further evidence that the person is endogenous or melancholic. Three somatic therapies are used for the treatment of depresson: tricyclic antidepressants, monoamine-oxidase inhibitors (MAOIs), and electroconvulsive threrapy (ECT).
Antidepressants are about equally effective in achieving effects, such as relieving low mood or loss of interest, they differ significantly in their side effects. One important way in which they differ is in the amount of sedation that they produce. If agitation and insomnia are important complains, a more sedating antidepressant such as Elavil can be select. In case of extreme lethargy, a doctor may select a more energizing antidepressant such as Norpramine.
These drugs may also differ in terms of the neurotransmitter systems that they act on. While there is some overlap. One drugs appeare to act on the noradrenergic systems in the brain ( Tofranil, Norpramine ), anothers act on the serotonin systems. Elavil seems to act on both systems. Thus it is reasonable to switch from one type of antidepressant to another if the patient does not respond adequately.
Antidepressants are relatively slow to act, often requiring two to three weeks in order to reduce target symptoms. Some patients feel quite a bit worse for the first few days. Dosages of tricyclics vary depending on the particular drug. Some patients feel their symptoms lift slowly and steadily over the course of days to weeks, while others report a change almost overnight after several weeks on the medication.
Antidepressants can produce different side effects. For example, tricyclics may activate adrenergic mechanisms in the heart in addition to those in the brain and produce dangerous abnormalities in cardiac rythm.
The MAOIs are used relatively infrequently because they have many more complications and side effects than do the tricyclics. In particular, the MAOIs can interact with a wide variety of popular foods to produce a dangerous and potentially life-threatening rapid rise in blood pressure.
Electroconvulsive therapy is another treatment sometimes used for depression instesad of tricyclics. ECT has been used for many years and is well recognies as one of the most effective treatments available for depression. Nevertheless, it has received a very bad press, and many people fear it. Modern ECT is given with adequate sedation beforehand and with use of muscle relaxants to prevent violent seizures. Most patients who rceive ECT have some memory loss for the period when they were receiving the treatment. These memory problems clear up completely after the ECT is stopped, however, and there is no evidence of any long-term effects on learning or memory.
1. The broken brain, Nancy C. Andersen, M.D., Ph.D., Harper and Row, Publishers, New York