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Office Psychiatry and the Primary Care Physician, Part II
Kenneth D. Cohen, MD, is clinical professor of psychiatry at the University of Pennsylvania Medical School, and training and supervising analyst at Philadelphia's center for Psychoanalysis. In Part 1 of this lecture, he defined depression as a disease of the mind, brain, and body. Here, he focuses on neurobiology and depression and provides an extensive review of antidepressant medications. The author discusses the parts of the brain affecting behavior and the impact of MRI and PET scans on understanding that link. He shows, with illustrations, how mood change affects brain structure and how, for instance, the amygdala mediates anxiety which is a symptom of depression. A section on neurotransmitters and depression describes the location and action of neurotransmitters. In an extensive review of antidepressant medications and interactions, Dr. Cohen discusses MAO inhibitors and selective serotonin inhibitors, the latter being the most frequently prescribed drug for depression ... and describes their method of action and appropriate dosage. Other drugs such as lithium for mood stabilizing in acute mania or hypomania and anticonvulsants are reviewed ... along with specific details on the indications, effectiveness, dosage, and interactions of valproate, carbamazepine, gabapentin, lamotrigine, toprimate, and oxcarbazepine. There follows a discussion of neurolepics in bipolar disorder, and accompanying charts clearly show the various medications and their indications, selection, monitoring, and maintenance. The lecture concludes with a section on suicidality, its relationship to depression, and how primary care physicians might approach and treat a suicidal patient. Persistence, patience, and perspective are useful guidelines. |
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