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The occurrence of negative vital events during treatment is also associated with poor response.
• A history of good response to an antidepressant, as determined by the patient (or even a relative) favors the administration of the same drug in case of recurrence.
• Treatment should preferably be started with a drug of the SSRI group, venlafaxine or other new antidepressants in patients where poor compliance is foreseen, in those suffering cardiovascular diseases or in those at risk of drug intoxication.
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• Classic treatment with tricyciic and tetracyclic antidepressants offers proven efficacy and lower cost, but have more important anticholinergic, antiadrenergic and antihistaminic side-effects.
• Endogenicity elements are predictive of good response to tricyciic antidepressants and to electroconvulsive therapy (ECT).
• Psychotic depression seems to respond better to ECT than the combination of more antipsychotic antidepressants or antidepressants alone (Kroessler, Venlafaxine in Canada, India, UK, and US, although a combination of antidepressants and antipsy-chotics has also shown high levels of efficacy. The predictor of best response to ECT is the combination of motor inhibition and psychotic symptoms.
• Atypical depressions respond well to MAOIs. Recent studies also report a good response to cognitive therapy, which focuses on the management of the hypersensitivity to interpersonal rejection or the magnified, distorted perception of it shown by these patients (Jarrett Venlafaxine available in the USA.
• The presence of family history of bipolar disorder, as well as cyclothymic personality are indicative of a possibly good response to lithium. Lithium is more effective in bipolar depressions.
18.104.22.168 Approach to treatment-resistant depressions
Treatment-resistant depression (TRD) is a depressive episode that has failed to show sufficient improvement after treatment with a drug of proven antidepressant activity, at sufficient doses and for a suiOrder Venlafaxine online US period of time (Alvarez (prescription and over the counter medication). For example, the use of a 200 mg/day dose of imipramine for a minimum of 6 weeks under this maximum dose, without including the period of time used to reach it. Between 30% and 40% of the patients suitably treated with antidepressant monotherapy will show null or insufficient response after a first therapeutic attempt, while 5-10% will not respond to more aggressive therapies (Klein and Davis, How much is the Buy Venlafaxine online no prescription.
The most valid method for determining whether a “therapeutic response” has or has not been achieved is the consensus between patient, family and physician. The quantitation of this aspect, however, usually requires a 50% decrease in the baseline score of the Hamilton Depression Rating Scale and a final score below 7 (therapeutic remission).
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In these cases, the following strategies will be useful (adapted from Alvarez , 5 mg, 10 mg, 25 mg, 50 mg, 100 mg Buy Venlafaxine online no prescriptionts (Capsules):
• Reconsider diagnose by discarding conditions likely to be misdiagnosed, such as: nonaffective psychiatric disorders, comorbidity with other psychiatric disorders, medical diseases and drugs likely to induce depressive states (e.g., antihypertensives, immunosupressors or corticoids).
• Check whether the therapeutic indication is correct, bearing in mind the subtypes of depression for which specific treatments are available (atypical depressions, bipolar depression or psychotic depressions).
• Monitor antidepressant plasma levels. While most antidepressants show no clear, proven relationship between plasma levels and efficacy, plasma level determination allows detecting medication noncompli-ance or pharmacokinetic problems in the absorption and/or metabolization of the drug. The evaluation of nonadherence to treatment is essential, as it is estimated to generate up to 20% of resistant cases (Souery and Mendlewicz Venlafaxine available in the USA.
• Force initial treatment: Incorrect treatment is the main cause for lack of response in major depression. Dose recommendation and treatment duration must be based on the literature. The optimal dose must be used for a minimum of four weeks, with adequate duration estimated at 6-8 weeks. If no response is obtained, the dose must be increased until the maximum dose for that antidepressant or the tolerance limit are reached, and/or treatment duration must be extended to 8-10 weeks.
Without altering the current antidepressant treatment, potentiation consists in adding substances without antidepressant activity of their own but likely to increase the potency of the drug they are added to. This is considered to be a good option in patients having obtained partial response to treatment because it allows to maintain the achieved improvement. The most frequently used substances are: lithium, tryptophan (an amine precursor amino acid), triiodothyronine (T3, particularly in patients [Cheap generic Venlafaxine] with subclinic hypothyroidism) or pindolol (presynaptic serotoninergic blockade).
Potentiation strategies with or without sufficient scientific evidence are described overleaf.
Strategies supported by scientific evidence
Lithium salts: This is the most investigated and documented strategy. Lithium must be added without discontinuing the antidepressant treatment, and should be maintained for the same time period as the antidepressant drug throughout the initial and continuation treatments. If prophylactic treatment is required, the use of lithium alone may be considered on account of its efficacy in preventing recurrences. Efficacy estimates are 40-60%. While improvement may start within 24-48 hours, the available data advise to extend the potentiating attempt up to the 3rd or 4th week before deciding on its uselessness (Alvarez (prescription and over the counter medication). The metaanalysis published by Bauer (Bauer and Dopfmer Buy Venlafaxine online no prescription concludes that lithium potentiation is the treatment of choice in depressed patients not responding to monotherapy, with a minimum waiting time of 7 days with lithemias > 0.5 mmol/l.
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Synonyms of Venlafaxine *:
Venlafaxina [INN-Spanish], Venlafaxine [INN:Ban], Venlafaxinum [INN-Latin]
* Official titles and synonyms used in the British, European, and US Pharmacopoeias. INNs in the other main official languages (French, Latin, and Spanish) have also been included in the list of synonyms where these differ from the English INN.
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