ABSTRACT
Increasing clinical experience with the selective serotonin reuptake inhibitors and tricyclic antidepressants make combination antidepressant therapy at times a reasonable alternative to single-agent therapy in primary care patients with depression. This article describes three cases that illustrate possible rationales for combination antidepressant therapy: reduced side effects, synergistic treatment effects, reduced treatment response time, prescriber familiarity, and clinical experience. The combination of selective serotonin reuptake inhibitors and tricyclic antidepressants may be useful in treating patients who experience intolerable side effects or who are resistant to therapy with a single antidepressant. Further research should be done to define the role of combination antidepressant therapy in the treatment of primary care patients with depression.
Subject(s)
Antidepressive Agents, Tricyclic/therapeutic use , Depression/drug therapy , Primary Health Care , Selective Serotonin Reuptake Inhibitors/therapeutic use , Adult , Antidepressive Agents, Tricyclic/adverse effects , Drug Synergism , Drug Therapy, Combination , Female , Humans , Selective Serotonin Reuptake Inhibitors/adverse effectsSubject(s)
Fibromyalgia/drug therapy , Fluoxetine/therapeutic use , Adult , Female , Humans , Middle AgedABSTRACT
The authors review the recent, conflicting findings of the effect of ECT on diabetes mellitus. To further explore this relationship, they present case reports of three adult-onset diabetic patients with varying degrees of diabetic management who were treated for depression with ECT. The results point to the variability of effects which ECT may have on blood glucose in diabetic patients. ECT may produce a potentially dangerous hyperglycemia in severely diabetic patients, but ECT does not appear to exert a major diabetogenic or diabetolytic effect on patients with mild diabetes mellitus. Possible mechanisms by which ECT affects blood glucose levels are discussed.
