By David S Baldwin; Jon Birtwistle
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Extra resources for An atlas of depression
It can induce the metabolism of anticoagulants and certain antidepressant and antipsychotic drugs, steroids and oral contraceptives. Carbamazepine can also exert teratogenic effects, possibly through causing iatrogenic folate deficiency. 44 summarizes the side-effects of the anticonvulsants. REFERENCES 1. Anderson IM, Nutt DJ, Deakin JFW. Evidence-based guidelines for treating depressive illness with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. J Psychopharmacol 2000;14:3–20 2.
The reported incidence varies widely, but symptoms are mild for most patients and usually resolve within 2 weeks. Comparative data are available for only the SSRIs, where paroxetine appears most likely, and fluoxetine least likely to be associated with discontinuation reactions1. Discontinuation symptoms appear less likely in shorter courses of treatment and if the drug dosage is tapered, but controlled evidence for tapering treatment is lacking. The March 2000 edition of the British National Formulary (BNF) states that abrupt withdrawal of an SSRI should be avoided.
The best results in bipolar illness are seen when treatment is good, there is a family history of bipolar illness and when episodes of mania are followed by depression. Poorer results are seen in rapid cycling illness, in patients with comorbid substance abuse and when paranoid features are present. When prescribed rationally and taken regularly, lithium can alter the course of bipolar affective disorder. There is also some evidence that lithium treatment can reduce the overall mortality associated with bipolar illness and reduce suicide rates.
An atlas of depression by David S Baldwin; Jon Birtwistle