Mood Disorders must be cured with therapies focused on each patient’s clinical traits. Therapy should be imagined as a tailor-made dress, sown by the tailor-doctor in full agreement with the patient, and should take into account the subject’s response to drugs. The patient is not object of the cure, but rather a member of the team.
Quite frequently, for example, a drug based therapy is imposed on a depressive patient without them having understood or been made aware of their therapeutic plan. In such cases, the prescription of psychotropic drugs may scare the patient and activate a resistance to therapy. This is why it is necessary to approach the matter with caution and give explanations. In most cases, drug treatment is undoubtedly effective, even more so when combined with supportive, expressive or cognitive-behavioural psychotherapy.
During hospitalization, our team provides a combined approach (psychiatric, psychological, neurological and internistic) and is available, also after discharge, for outpatient check-ups and/or follow-up phone calls.
Drug therapy is the most widespread, because it is rapidly effective and anyway less costly than months or years of psycotherapy. Anti-depressive drugs available in Italy are tryciclic antidepressants (TCAs), drugs acting on serotonin selective reuptake (SSRIs – serotonin selective reuptake inhibitors), on norepinephrine (NRI/NERI – norepinephrine reuptake inhibitors), and those acting on both serotonin and norepinephrine (SNRIs – serotonin-norepinephrine reuptake inhibitors), and antidepressants which modulate serotonergic and noradrenergic transmission (NaSSAs – noradrenergic and specific serotonergic antidepressants).
Following traditional studies on antidepressants, the patient’s response occurs at least 10-15 days after starting the treatment. However, based on experience in our institute there are clinical indicators which allow us to estimate a more rapid response to therapy, consequently reducing the time necessary to identify the most suitable medication (for instance, we could opt for a different drug on a same-day basis, based on a patient’s adverse reaction).
Psychotropic drugs re-modulate the neuronal system, re-balancing neurotransmitter functions, with benefits for the patient’s mood.
Psychotherapy allows the reprocessing of events, or crucial past and present conflictual issues, by means of transformative and therapeutic processes which certainly require more time, but can also lead to more durable results.
Cyclotimia and bipolar disorders are mainly treated with drugs, associating antidepressants and mood stabilizers.
For an optimum management of therapy, a few basic principles have to be taken into account:
- 1. at the start of therapy the choice of drug is based on the depressive disorder’s clinical traits, therefore guided essentially by symptoms, or by response to previous treatments (“psycho-pharmacological anamnesis”), or also based on a first degree relative’s response to similar drugs; in alternative, finally, based on “unconscious statistic”, i.e. the doctor’s experience gathered over years of practice.
- 2. response to drugs is always personal, and often unpredictable, at times paradoxical; for instance, a psychotropic drug which should also sedate may cause anxiety and, vice versa, one which should be stimulating could cause sleepiness, at times even unpleasant. Therefore, especially with outpatients, at first dosage prescription should be cautious. A drug inducing negative effects should be immediately replaced by others with different, maybe even opposite, pharmacodynamic traits. Whereas, if it leads to definitely positive effects, the dosage should be increased, even drastically. When possible, it is useful to test the drug by injection, better if intravenous. Often, a therapy’s failure is caused by insufficient dosage.
- 3. In some cases, especially in “non responding” patients, a combination of different antidepressants could be useful, bearing in mind any reciprocal incompatibility (this requires great medical experience). These antidepressants may be beneficially associated also with other drug categories, such as mood stabilizers or atypical neuroleptics.