ISSN:0885-6222    

DOI:10.1002/hup.470090701

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractMost reference antidepressants were discovered in the 1950s by serendipity and not as a result of knowledge of the mechanism of action or of a predictive pharmacological profile. During the 1960s, the principal effects of the older psychotropic drugs on neurotransmitters were identified. This led to two biochemical theories of depression being proposed, one involving the noradrenergic system and the other the serotonergic system. Most drugs however, interacted with both systems, and the few that demonstrated selectivity showed no corresponding differences in terms of clinical use. Two strategic approaches were adopted for the development of new compounds in the 1970s. One involved the selective inhibition of MAO‐A or MAO‐B and on the reversibility of the interaction with MAO. The second strategy was to develop selective serotonin reuptake inhibitors (SSRIs). These SSRIs appear equally effective to older compounds and are virtually devoid of interaction with the receptors of other systems such that side effects are either mild or abs

ISSN:0885-6222    

DOI:10.1002/hup.470090702

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractA clinical trial database which extends to 4126 depressed patients treated with paroxetine, 1954 patients on active control, and 625 placebo patients was analysed to assess the safety of treatment with paroxetine. A total of 451 patients included in the database were exposed to paroxetine for periods of one or more years. Paroxetine was generally better tolerated than comparator antidepressants with significantly fewer discontinuations due to adverse events. In particular, paroxetine was seen to be less likely to be associated with the development of seizures or manic episodes and appears to have a protective effect on the emergence of suicidal thoughts.

ISSN:0885-6222    

DOI:10.1002/hup.470090703

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractIn England and Wales the majority of suicides by poisoning are now attributable to one of five products–‐paracetamol, dextropropoxyphene, amitriptyline, dothiepin and temazepam. Most of the temazepam deaths occur when it is taken in combination with one or more other products. Co‐proxamol (dextropropoxyphene plus paracetamol) and paracetamol account for the majority of suicides by overdosage of analgesics.The ratio of the number of prescriptions dispensed to the number of fatalities varies considerably between antidepressants. The highest ratio is amongst the older tricyclics, it is lowest for the atypical antidepressants including the newer selective serotonin reuptake inhibitors. The variation in the fatality ratios of these compounds is related to differences in their inherent toxicity and compliance.Recognising the pattern of suicides from overdosage of drugs has important implications for prevention. Safety in overdose must be taken into account when prescribing drugs to patients who are at risk for su

ISSN:0885-6222    

DOI:10.1002/hup.470090704

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractMajor depressive disorder is a common psychobiological disorder which is frequently recurrent with multiple life‐time episodes. Effective medical treatments primarily with the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) have been available for many years, however, compliance and relapse have continued to be a significant problem. With the advent of newer antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), the issues of cost‐effectiveness have come into focus.Analysis of controlled antidepressant trials comparing SSRIs with TCAs have consistently demonstrated the cost‐effective advantage of the SSRIs over the TCAs, which is a direct reflection of the quality of response with better compliance, a more benign side effect profile and consistent advantage in clinical eff

ISSN:0885-6222    

DOI:10.1002/hup.470090705

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe effects of illness and its treatment on quality of life have become important considerations in drug evaluation. Quality of life is difficult to define showing great individual variability. It is not the same as ‘health’. It is concerned with the satisfaction of primary and secondary needs, satisfaction with life and the achievement of a sense of well being.Depression is a very common disorder and it has characteristic features which are likely to impair quality of life. Patients suffering from depressive symptoms have been shown to have worse physical and social functioning, spend more days in bed, have more bodily pains and worse current health than those with hypertension, diabetes mellitus and arthritis. Antidepressants have a broad spectrum of pharmacological effects and they may, in varying degrees, produce a range of side effects which can have a deleterious effect on quality of life. Side effect profile is therefore an important consideration in drug selection.Measurement of quality of life poses many problems. A number of general measures have been developed, but more specific devices are needed in assessing the impact of depression and its treatment.In health economic assessments the cost utility approach is favoured. This entails an assessment of the effect of new treatments on quality of l

ISSN:0885-6222    

DOI:10.1002/hup.470090706

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe most frequent subject of malpractice litigation in the United States concerns suicide or failure to exercise proper restraint of a patient. In applying the law of negligence to suicide, it has to be shown that the doctor had owed the deceased patient a duty of care, i.e. that the doctor‐patient relationship had existed. Furthermore, it has to be shown that the doctor's standard of practice did not conform to an appropriate known standard. The questions which need to be addressed are: was suicide predictable?; was reasonable care provided with necessary precautions implemented?; and was treatment reliably and dependably implemented?With regard to the foreseeability of suicide, major depression is a known actuarial predictor for suicide, but is suicide always predictable in cases of major depression? With respect to providing reasonable care and precautions, the doctor has to decide on the appropriateness of prescribing antidepressants which are lethal in overdose to potentially suicidal patients. The doctor is bound by ethical and legal requirements to obtain from his patient informed consent to treatment. In the case of toxic antidepressants, this would require him to warn the patient that treatment is toxic in overdose. In the case of the suicidal patient, provision of such information might seem to be negligent. Following the case of Rogersvs. Okin (1979) in Massachusetts, patients committed to the Boston State Hospital had a constitutional right to refuse treatment. Later the use of medication was allowed if the risk of violence outweighed the potential harm of the medication to the patient. However, the law clearly expects doctors to take the lead in defining appropriate standard

ISSN:0885-6222    

DOI:10.1002/hup.470090707

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractAntidepressants relieve depression, but many are highly toxic if taken in overdose, causing over 250 deaths in Britain each year. Ninety‐seven per cent of these deaths are due to the older tricyclic drugs. Prescribing antidepressant drugs with lower toxicity in overdose could prevent many of these deaths, and is thus the most immediately available from of suicide preventio

ISSN:0885-6222    

DOI:10.1002/hup.470090708

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

ISSN:0885-6222    

DOI:10.1002/hup.470090709

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY