Tag Archives: Nefazodone

Treatment of Anxiety in the Medically Ill

Psychotherapy An overemphasis on psychopharmacology in the care of medically ill patients may result in overlooking the value of psychotherapy. The first step in the treatment of anxiety is to spend time listening to and talking with the patient. Just as in psychotherapy with any patient, empathic listening is a powerful tool to relieve distress.… Read More »

Food and Efficacy of Psychotropic Medications

Question. I would like information about food/drink and medications. How significant is the impact on absorption availability? And, what is it about Serzone after SSRI? I have not usually seen that much difficulty switching patients from one medication to another but this one seems quite different. Answer. Foods seem to be a relatively minor factor… Read More »

When to Introduce Antipsychotics

Question. When do you feel antipsychotics should be used to treat anxiety? My patient is very distressed, cannot concentrate and has a hard time with rational thought. He suggested this as a possible option, but what do you think? Answer. Unless the anxiety is really secondary to a psychotic process, I would argue that the… Read More »

Pharmacological Treatment of Pain

While medications are often prescribed for all types of chronic pain, research has consistently shown that several classes have proven efficacy for the treatment of neuropathic pain. Ideally, pharmacotherapy of pain would be specifically selected on the basis of considerations of etiology (e.g., ischemic, neuropathic), pathophysiology (e.g., demyelination, central pain), and anatomy (e.g., C fibers,… Read More »

Minor Depression: Duloxetine, Venlafaxine, and Milnacipran

Serotonin-Norepinephrine Reuptake Inhibitors Several antidepressants have dual action at both serotonergic and noradrenergic receptors. The most notable are the serotonin/norepinephrine reuptake inhibitors, particularly extended-release venlafaxine (Wyeth’s Effexor XR) and milnacipran (bioMerieux-Pierre Fabre’s Ixel/Dalcipran, Asahi Kasei/Janssen-Kyowa’s Toledomin; available only in France and Japan). The noradrenergic and specific serotonergic antidepressants (NaSSAs) mirtazapine (Organon’s Remeron/Remergil), nefazodone (Bristol-Myers Squibb’s… Read More »

Minor Depression: Escitalopram, Paroxetine, Sertraline, and Fluoxetine

Selective Serotonin Reuptake Inhibitors The seven available agents in the selective serotonin reuptake inhibitor class are citalopram (Lund-beck’s Cipramil, Forest Laboratories’ Celexa, generics) and its single enan-tiomer, escitalopram (Lundbeck’s Cipralex, Forest’s Lexapro); paroxetine (GSK’s Paxil/Seroxat, Novartis’s Frosinor, generics); the controlled-release version of paroxetine (GSK’s Paxil CR); sertraline (Pfizer’s Zoloft); fluoxetine (Eli Lilly’s Prozac, generics); and… Read More »

Specific Migraine-Preventive Agents: Serotonin Antagonists

The antiserotonin, migraine-preventive drugs are potent 5-HT2B- and 5-HT2C-receptor antagonists, whereas metachlorophenyl piperazine (mCPP), a 5-HT2B- and 5-HT2C-receptor agonist, induces migraine in susceptible individuals. Methysergide, cyproheptadine, and pizotifen, effective migraine prophylactic drugs, are 5-HT2B-and 5-HT2C-receptor antagonists, whereas ketanserin, a selective 5-HT2A- and a poor 5-HT2B- and 5-HT2C-receptor antagonist, is not. mCPP, a major metabolite of… Read More »

Integrative Treatment of Depression and Comorbid Personality

The initial approach to patients with refractory or chronic depression begins with a comprehensive assessment of Axis I psychiatric disorders, including information from the patient as well as collateral sources. Unrecognized syndromal or subsyndromal psychiatric conditions (e.g., bipolar disorder, atypical depression, anxiety disorders, psychosis, substance abuse) may be found in some patients with chronic or… Read More »

Personality and Response to Antidepressant Medication

Personality Disorders Although the general consensus among clinicians is that patients who present with comorbid depression and personality disorders have a worse outcome, this is not always supported by research findings. Several large clinical investigations did find evidence to support an adverse outcome in depressed patients with comorbid personality disorders. In a study designed to… Read More »