Indian Write-Ups

The older generations of antidepressants have multi-system, multireceptor actions and a wide variety of side effects. The newer generations of antidepressants offer perhaps equipotent efficacy in depressive disorders; at the same time they are reputed to have fewer side effects because of selective system or selective receptor action.

In initial stages antidepressants were used predominantly in depressive disorders. Later, they have been increasingly used for various conditions where mood alteration is neither the predominant nor the presenting feature.

The belief that antidepressants work in diverse, medical conditions because the symptoms of these conditions may be the manifestations of an underlying masked depression is only partly true. It is also possible that antidepressants may have other therapeutic properties apart from their antidepressant action e.g. use of trimipramine in non-ulcer dyspepsia or amitriptyline and dothiepin as an analgesic. A prominent side effect of an antidepressant can also be used with advantage as a therapeutic effect e.g. trazadone in impotency.

In some instances the evidence of therapeutic efficacy of an antidepressant in a non-depressive disorder is based on open or small sample size studies. At other times the effective use of a specific drug has been documented in controlled studies. There are also studies where the specific indication is based on anecdotal evidence or single case reports.

It must be emphasized that antidepressants should be administered in adequate doses for at least six to nine months for lasting therapeutic benefit. The effect of these drugs is due to alteration in neurohumoral transmission, which is a relatively slow process.

As antidepressants will be usually used as adjuvant in the ongoing treatment of many medical conditions, drug-drug interaction should be taken into consideration when prescribing antidepressants.

The five broad classes of antidepressants are tricyclics (TCA), Monoamine Oxidase Inhibitors (MAOI), Specific Serotonin Re-uptake Inhibitors (SSRI), atypical antidepressants and mood stabilisers. Their use in non-psychiatric conditions is explained in tabular form in the text, for ease of reference.

Thus, apart from their conventional use in depressive illness, their indications have now diversified beyond depression to include a wide variety of medical disorders affecting almost every organ system in the body.

It is believed that familiarity with the non-psychiatric uses of antidepressant drugs would enhance clinical medical practice and add new weapons to the therapeutic armamentorium in general medical practice.