Antidepressants Can Be Immediately Effective

[sharon sanders]

Antidepressants ?can change the way depressed people see the world in just four hours?

Embargoed until Friday, July 04, 2008
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A single antidepressant tablet makes a depressed person see the world in a more positive light just four hours after swallowing it, a new study has shown.

Dr Philip Cowen, professor of pharmacology at the Department of Psychiatry at the University of Oxford, told delegates at the Royal College of Psychiatrists? Annual Meeting in London that antidepressant medication starts to work far faster than most clinicians assume.

?Depressed people interpret the world in a negative way,? he said. ?They become stuck in this state. Negativity causes depression and depression causes negativity and, whatever happens, events will be interpreted in a negative way.?

Antidepressants elevate mood, which in turn leads to a depressed person becoming more positive and interpreting things that happen to them in a positive way. Prof Cowen said: ?Antidepressants change biases. People who take them begin to see the world in a positive light,? said Prof Cowen

But it does not take weeks for this change to happen. Prof Cowen and his colleagues gave 30 depressed people one single 4mg dose of reboxetine ? which inhibits the update of both serotonin and noradrenaline in the brain ? and compared them with 30 ?controls? who were given a placebo or dummy pill.

The researchers asked both groups to carry out a series of simple tasks, including picking out the ?happy? facial expression from a line of faces, and recalling positive rather than negative words. They found that the placebo group were poor at spotting happy faces. They also tended to remember the negative words and were slow to categorise positive information.

However, four hours after taking a single dose of reboxetine, the drug group were as capable of remembering the positive words and spotting the happy expression as people who were not depressed.

Prof Cowen said: ?People with depression interpret their internal and external worlds in a negative way. The current antidepressant drugs take away the automatic feelings of negativity at the first dose.?

Antidepressants affect mood indirectly by abolishing the negative bias in the way that depressed people appraise personal and social experience at a subconscious level.

While there might be little change in overall conscious mood, Prof Cowen concluded: ?Over time, and with a fair wind, this can lead to feeling better and improve the changes of recovery.?



http://www.rcpsych.ac.uk/pressparliament/pressreleases2008/bank2008/amantidepressants.aspx

 

[Giuseppe]

Re: Antidepressants Can Be Immediately Effective

Antidepressants may be useless in some cases, notwithstanding the allure that shine around them.

Brains are differents, and although the chemicals are the same, no predictions are possible for all people.

Some patients respond well to single therapy, or combination therapy, with or without psychotherapy.

Other seem unresponsive also when anti-delirium compounds are administered (phenotiazide-derivative, also known as anti-DOPA).

Depressive syndromes are complex, and a patient-based therapy should be also considered instead a single drug will be administered, ''over-the-count''.

Further, some compounds side-effects, adverse reactions, addiction are poor understood at this time, along with the long-term mutagenic or carcinogenic properties.

Finally, for some newest drugs deprivation syndromes aren't properly investigated.

 

[Giuseppe]

Re: Antidepressants Can Be Immediately Effective

I think that the attention should be focused firstly into the different classes of drugs employed in anxiety disorders, dystimy and depression.

* Tricyclic derivatives: imipramine, trimipramine, chlormipramine, etc;

* SSRI (selective serotonin re-uptake inhibitors): sertraline;

* other serotoninergic: venlafaxine.

For the first class, the older, some side effects are well known and may reduce the complaining of patients to therapy.

SSRI are well tolerated, and they side effects are numerous and perhaps more concerning, such as the increasing chances of suicide since the level of fear in the patient is greatly reduced.

SSRI may also increase likelihood of hematological dyscrasy: trombocytopeny (low platelets count) with internal (GI tract) hemorrhages.

The effectiveness of these compounds in reduction of dystimy, and major depressive symptom take some weeks to enter in the maximum strenght, and it isn't linked with dose intake.

Conversely, anti-anxiety compounds, like benzodiazepine derivatives, are dose-dependent, and addiction may result after brief treatment course.

No clear data are available about long term side effect of newest drugs, and oncogenic, mutagenic properties could be underestimated at this time.

Other drugs are available to reduce both anxiety, delirium, unresponsive nausea and vomit, severe headache, and most stress-linked physical symptoms: they are so called anti-DOPA (antidopaminergic compounds), such as chlorpromazine derivatives, phenotiazides.

They interfere with central dopaminergic brain receptors with increase chances of long term parkinsonism development in younger patients.

Anti-DOPA may also result in weight gain, lipidic syndrome (higher level of fat in the blood), involuntary movement of the eyes, and other neurological symptoms.

SSRI and anti-DOPA may also cause severe neurological adverse events, in a few amount of patient with fatal outcomes. SSRI could cause serotoninergic syndrome (similar to some conditions experienced by IDUs with methamphetamine addiction), with uncontrolled fever, convulsion, breath difficulties and coma. Anti-DOPA could cause the so-called neuroleptic malignant syndrome, with parkinson-like signs.

Some of the compounds cited may alter the central thermoregulatory centre, and impair proper body thermal control.

Anti-DOPA may reduce production of blood white cells, even with no reversible conditions (one of the worst side effect of compazine, or prochlorperazine).

Anti-DOPA and SSRI, triciclic derivatives aren't dose-dependant conversely the benzodiazepines.

Some antimicrobial (antiviral) properties were anectodal for anti-DOPA compounds and perhaps a further research in this field may be useful.

I hope that some other FT members may add further informations to this brief - non-specialistic - overview, based mainly on first hand experience with these drugs.

 

[Francoise Ramona]

Re: Antidepressants Can Be Immediately Effective

Yes, I can, but in french.....it's possible ??

 

[Giuseppe]

Re: Antidepressants Can Be Immediately Effective

Yes, I can, but in french.....it's possible ??

Yes. All informations are useful. If interested the readers may use machine translators. Or cooperate in english translation with you.

 

[sharon sanders]

Re: Antidepressants Can Be Immediately Effective

Yes, I can, but in french.....it's possible ??

Yes Lili61, please post in French. We can translate.

Thanks to both Ironorehopper and Lili61.

 

[Francoise Ramona]

Re: Antidepressants Can Be Immediately Effective

En psychiatrie, nous avons trois grandes familles de m?dicaments.

Les benzodiaz?pines, utilis?es comme anxiolytiques, hypnotiques et myorelaxants essentiellement..
Ce sont des produits qui agissent vite mais qui induisent une accoutumance et une d?pendance au del? de 3 mois de traitement continu..
Accoutumance = necessit? d'augmenter les doses pour le m?me effet
D?pendance = impossibilit? de se passer du produit

Les antid?presseurs utilis?s pour les troubles de l'humeur, avec ou sans id?es suicidaires, les ?tats d?pressifs.

Les anciens, les tricycliques sont encore utilis?s en cas d'echec des ISRS, jamais en premi?re intention.
Leurs effets secondaires sont importants et leur toxicit? cardiaque rend leur utilisation limit?e,surtout chez les sujets ag?s.
Les ISRS les plus utilis?s:
citalopram, parox?tine, fluox?tine, sertraline....

Les effets secondaires les plus g?nants dans la vie quotidienne sont, les transpirations excessives, les troubles de la libido.

Une grande pol?mique est li?e aux suicides et surtout chez l'adolescent, lors de l'utilisation des ISRS.
En fait, le d?but d'un ?tat d?pressif se manifeste, entre autres, par deux grands signes, les troubles de l'humeur et l'apragmatisme. Cette derni?re notion est l'impossibilit? qu'a le sujet de passer ? l'acte. Passer ? l'acte pour savoir quoi acheter ou quoi faire ? manger...comme quoi faire pour se tuer.
L' ISRS am?liore d'abord l'apragmatisme avant de modifier l'humeur, ce qui a pour r?sultat que, pendant quelques jours ou 1-2 semaines, le sujet est toujours triste et peut passer ? l'acte.
C'est pour cette raison qu'il est important de toujours ?valuer la composante suicidaire chez un d?pressif ( elle n'est pas obligatoire ) avant de donner un ISRS. Si on le donne chez un suicidaire, on l'associera pendant 3-4 semaines avec un anxiolytique.

les effets secondaires sanguins ou autres sont tr?s rares.


Le d?lai d'action est variable, certains se sentent mieux apr?s quelques jours de traitement, d'autres attendent 3-4 semaines. Je pense que l'effet rassurant de la prescription est importante pour certains et les am?liore vite.
Mais 4 heures........je n'ai jamais vu

La troisi?me famille est celle des neuroleptiques, ce sont les m?dicaments de la psychose.

Les m?dicaments traitent le sympt?me, les psychoth?rapies prennent en compte les causes du trouble.

Je vais peut ?tre stopper l?, sinon, je remplie des pages

 

[Oracle]

Re: Antidepressants Can Be Immediately Effective

In psychiatry, we have three big families of drugs. Benzodiazepines, used as primarily anxiolytic, hypnotic and myorelaxants . In fact, (these) products act quickly but induce a habituation and a dependence beyond 3 months of continuous treatment.

Habituation = required to increase the amounts for the same effect Dependence = impossibility of doing without the product.

Antidepressants used for the disorders of low mood, with or without suicidal ideas, depressive states. The old(est class of antidepressant) ones, the tricyclic ones are still used in case failure of the ISRS, never in first intention. Their side effects are important and their cardiac toxicity returns their use limited, especially at (in) old(er) subjects. The most used ISRS: citalopram, parox?tine, fluox?tine, sertraline?. The most awkward side effects in the daily life are: excessive perspirations and disorders of the libido. A great polemic (statement beyond reproach) is the inter-dependent on the (of) suicides (especially among) teenagers at the (start of use) time of the ISRS. In fact, in the beginning, a depressive state appears, inter alia, by two large signs, the disorders of low mood and (loss of ) pragmatism.

This last concept is (dichotomous) impossibility; the subject has to act to succeed (in suicide). To pass to l' act to know what to buy or what to make with manger...com me what make to commit suicide. (I presume that she means that in chronic severe depression, patients are often unable to put together a plan for suicide because they are passivated by their illness) The (danger is that) ISRS improves pragmatism before modifying (low) mood, which has as a result that, during a few days or 1-2 weeks, the subject is always sad and can pass to act (carry out suicide). This is for this reason why it is important always to evaluate the suicidal component of depressives (although not obligatory) before giving a ISRS. If one gives it to a suicidal, one l' will associate during 3-4 weeks with anxiolytique. Blood side-effects or others (side effects) are very rare. The time d' action is variable, (some) certain(ly) feel better after a few days of treatment, but others await (take as long as) 3-4 weeks (to respond). I think that its a reassuring effect, regulation is important (I think she means return to normalized daily living patterns is important and helps restore patients to a more normal stress tolerance) for certain and improves them quickly.

But 4 hours ........ I never saw (this).

(I concur with Lili. The effect of nearly immediate relief reported by patients in this survey is more likely a well annotated placebo effect rather than direct pharmacological action, because cellular components must turn over and gene expression shifts before actual chemical effect of sufficient magnitude for verifiable effect occurs.)

The third family is that of nerve sedatives, they are the drugs of the psychosis. The drugs treat the symptom, psychotherapies take into account the causes of the disorder.

I go can be to stop there, if not (more), I filled the page (message box).

 

[Thornton]

Re: Antidepressants Can Be Immediately Effective

As a psychiatrist trained in clinical psychopharmacology I come from a specific biased orientation. The work cited in post 1 describing observable effects within 4 hours was a very specific observation on a limited psychological task. It is intriguing and may help clinical research but it does not mean that current drugs remit depression in 4 hours. There are numerous drugs that can improve mood within minutes or hours but they are not useful in treating the disorder we describe as Major Depression in DSMIV.

I recommend as a resource on the topic the National Institutes of Mental Health web site
http://www.nimh.nih.gov/health/topics/depression/index.shtml

and the Depression Bipolar Support Alliance web site
http://www.dbsalliance.org/site/PageServer?pagename=home

re: post # 2 I have to advise that the tricyclic medications although just as effective as most other antidepressants have very limiting side effects (dry mouth, blurred vision, constipation, dizziness and acute angle glaucoma). They are also lethal in overdose eg a two week supply is dangerous. In my opinion the tricyclic antidepressants should be removed from the market.

Two aphorisms say a lot about any use of medications for any condition:
1. Use the new drugs while they still work
2. A drug without side effects is a drug without effect.

Longitudinal clinical trials from the University of Pittsburgh support the value of combined medications and psychotherapy. for preventing recurrences of depression.

The primary prevention of depression is to develop and maintain a positive attitude (optimism) try to keep on a regular schedule for sleep, exercise and meals, develop and maintain significant relationships, develop spiritual meaning in life.
Peace
Joe Thornton, MD