Nomdeplume
Aangesluit op 20 Februarie 2006
Content deleted Content added
kNo edit summary |
kNo edit summary |
||
Lyn 99:
[[wildsbok]]
</small>
<!--'n '''Antidepressant''' is 'n [[geneesmiddel]] wat die [[simptoom|simptome]] van 'n [[major depressiewe versteuring|depressie]] behandel of verlig. Sommige antidepressante, veral die [[trisikliese antidepressant]]e, word gebruik vir ander nie-amptelike indikasies, soos die pyn veroorsaak deur [[neuropatie]]. Heelwat van die antidepressante is ook aangedui in die behandeling van [[angsversteuring]]s.
Alle antidepressante is min of meer ewe effektief, maar dié wat later ontwikkel is, het meestal minder [[newe-effek]]te, en 'n kleiner kans om dodelik te wees in [[oordosering]].
==Geskiedenis==
Die antidepressante werking van hierdie geneesmiddels is toevallig ontdek. Die middel wat alles begin het in die [[1950s]] was [[iproniasied]], 'n middel vir die behandeling van [[tering]]. Iproniasied was 'n [[mono-amienoksidaseblokkeerder]]s (MAOIs).
==Klasse en soorte==
Sien die [[lys van psigiatriese geneesmiddel-ingrepe|lys van antidepressante]].
==Hoe werk dit?==
Antidepressante se geneeskundige effek vind waarskynlik plaas op die [[neuro-oordragstof]]vlak. Die meeste antidepressante veroorsaak 'n verhoging van [[serotonien]] en [[noradrenalien]]. Nuwe getuienis toon dat dié verhogings die verhoogde produksie intra-sellulêr van 'n [[neurotrofiese groeifaktor]] veroorsaak, en dit op sy beurt die hergenerering van [[neuron|senuweeselle]] in die [[hippokampus]] tot gevolg het.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11124987&query_hl=4][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11137860&query_hl=2]. Verdere onlangse navorsing dui daarop dat antidepressante 'n uitwerking het op sogenaamde "klokgene" (transkripsiefaktore) wat op hul beurt betrokke is by die meganismes van [[substansmisbruikmiddel]]s en moontlik ook [[vetsug]]. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15994025&query_hl=24], en [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16094306&query_hl=27][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16288309&query_hl=24].
==Toleransie en afhanklikheid==
Die middels veroorsaak nie toleransie nie, maar skielike ontrekking kan fisiese [[newe-effek]]te veroorsaak.
==Newe-effekte==
Die gebruik van antidepressante kan newe-effekte veroorsaak. 'n Onvermoë om dit te kan verduur is die mees algemene rede tot staking van die geneesmiddels.
===Algemene newe-effekte===
*Veral die [[serotonienheropnameblokkeerder]]s, en veral dié met 'n korter [[halfleeftyd]], kan fisiese onttrekkingsimptome veroorsaak.
*MAOIs kan 'n dodelike verhoging in [[bloeddruk]] veroorsaak as dit ingeneem word met [[voedsel|kosse]] ryk aan [[tiramien]], soos [[kaas]] en [[wyn]].
*
Antidepressants often make the [[mania|manic]] component of [[bipolar disorder]] worse, and should be used with great care in the treatment of that disorder, usually in conjunction with [[mood stabilisers]]. Their use should be monitored by a psychiatrist, but in countries such as [[New Zealand]], the [[United Kingdom]] and the United States, primary care physicians are able to prescribe antidepressants without consulting a psychiatrist.
In particular, it has been noted that the most dangerous period for [[suicide]] in a patient with depression is immediately after treatment has commenced, as antidepressants may reduce the symptoms of depression such as [[psychomotor retardation]] or lack of motivation before mood starts to improve. Although this appears to be a paradox, studies indicate the suicidal ideation is a relatively common component of the initial phases of antidepressant therapy, and it may be even more prevalent in younger patients such as pre-adolescents and teenagers. It is strongly recommended that other family members and loved ones monitor the young patient's behavior, especially in the first eight weeks of therapy, for any signs of suicidal ideation or behaviors.
===Sexual===
[[Sexual dysfunction]] is a very common side effect, especially with [[Selective serotonin reuptake inhibitor|SSRIs]]. [[Bupropion]], a DRI, in many cases results in a moderately increased libido. Some clinicians have found that adding bupropion to a regimen of SSRI medications can sometimes alleviate some degree of sexual dysfunction. However, the mechanism of action for bupropion appears to be unique and quite different from other mood elevators, among these being a stimulant-like effect and concurrent insomnia, especially in the first few weeks of use. Moreover, some patients, as seen with most psycho-active drugs, cannot tolerate it at all.
==Opioids==
Opium has been known as an antidepressant since Biblical times.[http://opioids.com/red.html] Various [[Opiates]] were commonly used as antidepressants until the mid-1950s, when they fell out of favor with medical orthodoxy due to their addictive nature. A [[clinical trial]] conducted at Harvard Medical School in 1995,[http://opioids.com/buprenorphine/buprefdep.html] demonstrated that a majority of treatment-refractory, unipolar, non[[psychotic]], major depression patients could be successfully treated with an opioid medication called [[Buprenorphine]]. While opioids have been proven to substantially relieve symptoms of depression, re-acceptance of this fact has been severely hampered by governmental narcotic [[Prohibition (drugs)|prohibition]] efforts.
==Controversy==
Several studies have stimulated doubt about the effectiveness of antidepressants. The studies cite that the difference between antidepressants and placebo is negligible. Antidepressants work only slightly better than placebo, and the Food and Drug Administration has not informed physicians of how little benefit most of these depression drugs offer (Kirsch I, Moore TJ, Scoboria A, Nicholls SS (2002a), The emperor's new drugs: an analysis of antidepressant medication data
submitted to the U.S. Food and Drug Administration. Prevention & Treatment 5:Article 23[http://journals.apa.org/prevention/volume5/toc-jul15-02.html]).
Through a Freedom of Information Act request, two psychologists obtained 47 studies used by the FDA for approval of the six antidepressants prescribed most widely between 1987-99. Overall, antidepressant pills worked 18 % better than placebos, a statistically significant difference, "but not meaningful for people in clinical settings," says University of Connecticut psychologist Irving Kirsch. He and co-author Thomas Moore released their findings in "Prevention and Treatment," an e-journal of the American Psychological Association.
More than half of the 47 studies found that patients on antidepressants improved no more than those on placebos, Kirsch says. "They should have told the American public about this. The drugs have been touted as much more effective than they are." He says studies finding no benefit have been mentioned only on labeling for [[Celexa]], the most recently approved drug. The others included in his evaluation: [[Prozac]], [[Paxil]], [[Zoloft]], [[Effexor]] and [[Serzone]].
Additional papers have been published regarding the benefits of atypical vs. typical antidepresants. These are timely papers given the need for [[Evidence based medicine|evidence based medicine]], as well as the cost of health care. Discussion of a key paper reviewing this topic titled "Quantitative analysis of sponsorship bias in economic studies of antidepressants" can be found at an [http://journalreview.org/view_pubmed_article.php?pmid=14645020&specialty_id=18 an on line journal club]
==Alternative medicine==
Despite controversy, alternative treatments for depression such as the herbal remedy [[St John's wort]] and the amino acid derivative [[S-adenosyl methionine|SAM-e]] have also gained popularity in recent years, although their effectiveness varies. Clinical trials have shown SAM-e to be as effective as standard antidepressant medication, with many fewer side effects (Delle Chiaie et al., 2002; Mischoulon and Fava, 2002). Most studies conclude that St. John's wort is usually as effective against depressions as other modern medication, again with fewer side effects, and it is widely prescribed for depression in [[Europe]]. However, a recent study showed St. John's wort to be no more effective than a placebo in cases of severe depression (Hypericum Depression Trial Study Group, 2002). [[Tryptophan]] dietary supplements, although banned in many countries due to impurities that caused a blood disease, have also been used as natural antidepressants. Dietary supplements of [[5-HTP]], a chemical the body forms from tryptophan and uses to make serotonin, have shown some promising research results but need further study.
==References==
* Roberto Delle Chiaie, Paolo Pancheri and Pierluigi Scapicchio. (2002). Efficacy and tolerability of oral and intramuscular S-adenosyl- L-methionine 1,4-butanedisulfonate (SAMe) in the treatment of major depression: comparison with imipramine in 2 multicenter studies. Am J Clin Nutr, 76 (5): 1172S-1176S
* Mischoulon D, Fava M. (2002). Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr, 76 (5): 1158S-61S.
* Hypericum Depression Trial Study Group (2002). Effect of Hypericum perforatum (St John's Wort) in Major Depressive Disorder: A Randomized Controlled Clinical Trial. JAMA, 287 (14):1807-1814.
==External links==
* [http://www.drada.org/ReferenceShelf/goldstein.html Pharmacological treatment of Mood Disorder]
* [http://www.emental-health.com/depr_history.htm#1950s A brief history of depression - 1950s]
* [http://www.emental-health.com/depr_treatment.htm#antidepressantdrugs Treating depression - Antidepressant drugs]
* [http://www.nih.gov/news/pr/aug2003/nimh-07.htm Creation of New Neurons Critical to Antidepressant Action in Mice]
* [http://cerhr.niehs.nih.gov/chemicals/fluoxetine/fluoxetine_final.pdf NIH Expert Panel Report on the reproductive and developmental toxicology of Prozac (Fluoxetine)]
* [http://cerhr.niehs.nih.gov/chemicals/fluoxetine/fluoxetine_monograph.pdf NIH Monograph on the potential human reproductive and developmental effects of Prozac (Fluoxetine)]
* [http://www.psych.org/psych_pract/treatg/pg/Depression2e.book.cfm American Psychiatric Association 2000 Practice Guideline for the Treatment of Patients with Major Depressive Disorder]
* [http://www.bap.org.uk/consensus/antidepressant.pdf British Association for Psychopharmacology 2000 Evidence Based Guidelines for Treating Depressive Disorders with Antidepressants]
[[Category:Antidepressants| ]]
[[de:Antidepressivum]]
[[fi:Masennuslääke]]
[[fr:Antidépresseur]]
[[ja:抗うつ薬]]
[[nl:Antidepressivum]]
[[pt:Antidepressivo]]
[[ru:Антидепрессанты]]
[[sv:Antidepressiva läkemedel]]
[[uk:Антидепресант]]
-->
| |||