TREATMENT OF DEPRESSION

I. Pharmacological

A. Monamine Oxidase Inhibitors (MAOI’s)

B. Tricyclic Antidepressants (TCA’s)

C. Selective Serotonin Reuptake Inhibitors (SSRI’s)

D. Mixed Serotonergic-Noradrenergic Agents

E. Dopaminergic-Noradrenergic Agents

F. Anticonvulsant Agents

II. Electroconvulsive Therapy (ECT)

A. Most efficacious depression treatment

B. Most rapid onset of action

C. Effective for severe depression, mania

D. Treatment of choice for severe depression with psychosis, pregnancy, suicidality, catatonia

E. Requires general anesthesia

F. Memory loss, cardiovascular risk

G. Can be done as outpatient

III. Psychological Therapies

A. Psychoanalytic

B. Interpersonal Therapy

C. Behavioral Approaches

D. Cognitive-Behavioral Therapy

IV. Light Therapy

A. For depressive phase of Seasonal Affective Disorder (SAD)

B. Unlikely to help other types of depression

C. Useful in women who are pregnant, nursing

D. Need to titrate dose (duration of exposure)

E. Agitation, eye strain

THERAPEUTIC DOSE RANGES OF SSRI’s

n Fluoxetine 20 – 80 mg

n Paroxetine 40 – 60 mg

n Setraline 50 – 200 mg

n Fluvoxamine 100 – 300 mg

n Clomipramine 150 – 300 mg

n Citalopram 20 – 60 mg