TABLES

Table 1.1 Critical Variables in Diagnosis 12

Table 1.2 DSM-IV Diagnostic Criteria for a Major Depressive Episode 14

Table 1.3 Signs and Symptoms of Different Types of Affective Episodes 16

Table 2.1 Unipolar Depression in the United States 22

Table 2.2 The Hidden Cost of Not Treating Major Depression 22

Table 2.3 Suicide and Major Depression: The Rule of Seven 23

Table 2.4 Risk Factors for Major Depression 25

Table 3.1 Typical Behavior During Office Visit 34

Table 3.2 Varied Terms Used for Depressed Mood 37

Table 4.1 Risk Factors For Suicide: “SAD PERSONS” Scale 40

Table 4.2 Patient’s Typical Questions About Major Depression 43

Table 5.1 What Is “Response” and “Remission” in Major Depression? 53

Table 5.2 Predictors of Placebo Response in “Depressed” Patients 53

Table 5.3 Factors Related to Noncompliance 55

Table 6.1 Classification of Antidepressants By Putative Mechanism(s) of Action Responsible for Antidepressant Efficacy: Generic/(Trade) Names By Drug Class 58

Table 6.2 Comparison of the Mechanisms of Action of Antidepressants 62

Table 6.3 Sites of Action and Clinical and Physiologic Consequences of Blockade or Antagonism 66

Table 6.4 Comparison of the Placebo-Subtracted Incidence Rate (%) of Frequent Adverse Effects for Citalopram, Fluoxetine, Fluvoxamine, Paroxetine, and Sertraline 68

Table 6.5 Comparison of the Placebo-Subtracted Incidence Rate (%) of Frequent Adverse Effects for Bupropion, Imipramine, Mirtazapine, Nefazodone, and Venlafaxine 72

Table 6.6 The Most Likely Specific Adverse Effects on Specific SSRIs Above and Beyond the Parallel Placebo Condition (Percentage on Drug Minus Percentage on Placebo Based on Registration Studies) 76

Table 6.7 The Most Likely Specific Adverse Effects on Specific Antidepressants Above and Beyond the Parallel Placebo Condition (Percentage on Drug Minus Percentage on Placebo Based on Registration Studies) 78

Table 6.8 Amitriptyline: Polydrug Therapy in a Single Pill 83

Table 6.9 Effect of Cytochrome P450 Enzymes on Specific Drugs (ie, Metabolism) 90

Table 6.10 The Inhibitory Effect of Newer Antidepressants at Their Usually Effective Minimum Dose on Specific CYP Enzymes 94

Table 6.11 Summary of Formal In Vivo Studies of the Effects of Different SSRIs on CYP 2D6 Model Substrates 96

Table 6.12 Symptoms of Anticholinergic Withdrawal Syndrome 100

Table 6.13 Symptoms of Serotonin Reuptake Inhibitor Withdrawal Syndrome 101

Table 7.1 STEPS Criteria for Selecting an Antidepressant 106

Table 7.2 STEPS Criteria for Mixed Reuptake and Neuroreceptor Antagonists (eg, Amitriptyline) 107

Table 7.3 STEPS Criteria for Norepinephrine Selective Reuptake Inhibitors (eg, Desipramine) 108

Table 7.4 STEPS Criteria for Serotonin Selective Reuptake Inhibitors (eg, Sertraline) 109

Table 7.5 STEPS Criteria for Serotonin and Norepinephrine Reuptake Inhibitors (eg, Venlafaxine) 110

Table 7.6 STEPS Criteria for Serotonin-2A Receptor Antagonist and Weak Serotonin Reuptake Inhibitors (eg, Nefazodone) 111

Table 7.7 STEPS Criteria for Serotonin (5-HT2A and 5-HT2C) and Norepinephrine (a-2) Receptor Antagonists (eg, Mirtazapine) 112

Table 7.8 STEPS Criteria for Dopamine and Norepinephrine Reuptake Inhibitors (eg, Bupropion) 113

Table 7.9 STEPS Criteria for Monoamine Oxidase Inhibitors (eg, Tranylcypromine) 114

Table 7.10 Average Wholesale Price of Representative Doses of Antidepressants 126

Table 7.11 Summary of Package Insert Dosing Guidelines 130

Table 8.1 Percentage of New Prescriptions Written for Specific Antidepressants During October, 1998 138

Table 8.2 Indications Formally Labeled By the FDA for Specific Sertonin Selective Reuptake Inhibitors 148

Table 10.1 Percentage of Patients on Antidepressants Having the Potential to Experience a Drug-Drug Interaction as a Function of Treatment Setting 180

Table 10.2 Prevalence of Major Depression in Specific Medically Ill Populations 182

FIGURES

Figure 1.1 Diagnostic Criteria Pyramid 12

Figure 3.1 Diagnostic and Treatment Planning Process 30

Figure 6.1 Relative Potency for Different Sites of Action for Three Different Types of Antidepressants: Amitriptyline, Desipramine, and Sertraline 81

Figure 6.2 In Vivo Profile of SSRIs on SE Uptake Inhibition Versus CYP Enzyme Inhibition 82

Figure 6.3 Relative Potency for Different Sites of Action for the Various Members of the SSRI Class of Antidepressants 85

Figure 6.4 Relative Potency for Different Sites of Action for Non-SSRI Antidepressants: Bupropion, Imipramine, Mirtazapine, Nefazodone, and Venlafaxine 86

Figure 6.5 How Knowledge of CYP Enzymes Will Simplify Understanding of Pharmacokinetic Interactions 99

Figure 9.1 Algorithm for Treating Patient With Major Depression 175

Figure 9.2 Zung Depression Self-Report Rating Scale 176