A selective serotonin reuptake inhibitor (SSRI) is generally used for initial treatment of major depressive disorder (MDD). A serotonin-norepinephrine reuptake inhibitor (SNRI), bupropion (Wellbutrin SR, and others), and mirtazapine (Remeron, and others) are reasonable alternatives. Improvement in symptoms can occur within the first two weeks of treatment with these drugs, but a substantial benefit may not be achieved for 4-8 weeks.

Complete remission of symptoms is the goal of treatment for major depressive disorder; a partial response is associated with an increased risk of relapse. Improvement in symptoms can occur within the first two weeks of treatment with an antidepressant, but it may take 4-8 weeks to achieve a substantial benefit. Following successful treatment of a first major depressive episode, antidepressant treatment should be continued at the same dose for at least 4-9 months to consolidate recovery. In patients with recurrent depressive episodes, long-term maintenance treatment can reduce the risk of relapse.

Complete remission of symptoms is the goal of antidepressant therapy; partial response is associated with an increased risk of relapse. Improvement can occur within the first two weeks of drug therapy, but it may take 4-8 weeks to achieve a substantial benefit. Fewer than 50% of patients with depression respond to first-line pharmacotherapy, and the rate of response decreases with each subsequent drug trial. Following remission after a first episode of depression, many experts recommend continuing antidepressant treatment at the same dose for at least 6-12 months to consolidate recovery. For patients with recurrent depressive episodes, long-term maintenance therapy can reduce the risk of recurrence.

The FDA has approved the marketing of another extended-release brand-name formulation of the serotonin and norepinephrine reuptake inhibitor (SNRI) desvenlafaxine (Khedezla – Par/Osmotica) for treatment of depression. It is the third extended-release formulation of desvenlafaxine to become available in the US. Khedezla was approved using a 505(b)(2) application, a new drug application (NDA) that relies upon the FDA's findings of safety and/or effectiveness for a previously approved drug.

Khedezla does not appear to offer any advantage over the other extended-release formulations of desvenlafaxine. There is no evidence that any formulation of desvenlafaxine is more effective for treatment of depression than other SNRIs or any SSRI, which are available in less expensive generic formulations.1

1. Drugs for psychiatric disorders. Treat Guidel Med Lett 2013; 11:53.

Download complete U.S. English article

The FDA has approved levomilnacipran (lee" voe mil na' si pran; Fetzima – Forest), a serotonin and norepinephrine reuptake inhibitor (SNRI), for treatment of major depressive disorder. Levomilnacipran is the more active enantiomer of milnacipran (Savella), which was approved in 2009 for management of fibromyalgia. Fetzima has not been studied in fibromyalgia.

Drugs are not the only treatment for psychiatric illness. Psychotherapy remains an important component in the management of these disorders, and cognitive behavioral therapy (CBT) can be used for many of them as well. Electroconvulsive therapy (ECT) has a long history of efficacy and safety when drugs are ineffective or cannot be used.

The primary symptoms of menopause are vasomotor and genitourinary. Vasomotor symptoms ("hot flashes") cause daytime discomfort and chronic insomnia. A thin, dry vaginal lining and thin urethral mucosa can cause vaginal and vulvar irritation, pain during intercourse, and an increased risk for urinary tract infection.

Drugs are not the only treatment for mood disorders. Psychotherapy remains an important component in the management of these disorders, and electroconvulsive therapy (ECT) has a long history of efficacy and safety when drugs are ineffective, poorly tolerated or cannot be used. Some drugs are recommended here for indications that have not been approved by the FDA.

Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.

Click here to view the free full article.

The FDA has approved the marketing of desvenlafaxine (Pristiq - Wyeth), the main active metabolite of venlafaxine (Effexor, and others - Wyeth), for treatment of major depressive disorder. Venlafaxine, a norepinephrine and serotonin reuptake inhibitor (SNRI), is available generically as an immediate-release tablet. Venlafaxine extended-release capsules (Effexor XR) are scheduled to go off-patent in 2010.