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Prognostic Factors in mood disorder

Good Prognostic Factors
  1. Acute or abrupt onset                                   
  2. Typical clinical features                 
  3. Severe depression
  4. Well adjusted pre morbid personality        
  5. Good response to treatment.
Poor Prognostic Factors
  1. Co-morbid medical disorder(s), personality disorder(s) or alcohol dependence
  2. Double depression (acute depressive episode superimposed on dysthymia)
  3. Catastrophic stress or chronic ongoing stress
  4. Unfavorable early environment
  5. Marked hypochondriacal features, or mood incongruent psychotic features
  6. Poor drug compliance.
Course:  Usual course of Depression: 6-9 Months

Classification Of Antidepressants Drugs
  1. Reversible inhibitors of MAO-A (RIMAS) Moclobemide, Clorgyline
  2. Tricyclic antidepressants (TCAs)
    1. NA + 5-HT reuptake inhibitors
      Imipramine, Amitriptyline, Trimipramine, Doxepin, Dothiepin, Clomipramine.
    2. Predominantly NA reuptake inhibitors
      Desipramine, Nortriptyline, Amoxapine, Reboxetine
  3. Selective serotonin reuptake inhibitors (SSRIs)
    Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram, Escitalopram
  4. NASSA- Mirtazapine
  5. SNRI   - Venlafaxine, Duloxetine
  6. SSRE   - Tianeptine
  7. NDRI  - Bupropion.
  8. NSRI   - Milancipram
  9. Atypical antidepressants - Trazodone, Mianserin
Safety profile: SSRI”S are safer than Tricyclics in overdose
For severe depression The drug of choice is TCA and for mild to moderate depression all the Drugs are equally effective and the choice depends upon the Side -Effect profile of drugs.
Treatment of choice for severe depression with psychotic symptoms is E.C.T. and also for depression with suicidal attempts or severe suicidal ideas is E.C.T. (Electro- Convulsive Therapy) or Antidepressants & antipsychotics.

Drugs of choice
  1. Elderly  : SSRI
  2. Suicidal : SSRI
  3. Nicotine dependence  : Bupropion
  4. Peptic ulcer : Doxepin
  5. Atypical depression : MAOI’S
  6. Psychotic depression : Amoxapine
  7. Eating disorder : Fluoxetine
  8. Panic disorder : SSRI

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