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expanded to include the
serotonin system as a cause for
depression. This research has led to
the use of drugs for treatment of
depression that affect changes in
monoamine uptake and enzymatic
metabolism.1
While
many of the depression treatments based
on the monoamine theory appear to be
initially useful, many of them lack the
short-term and long-term efficacy needed
for relief of symptoms in most patients.
In several studies of reuptake
inhibitors administered only 8% to 13%
of subjects obtained relief of symptoms
greater than placebo. Remission rates
for escitalopram compared to placebo in
adults was studied (48.7% versus 37.6%,
P=0.003). Here, 11.1% of subjects
obtained relief greater than placebo.35
Remission rates for citalopram
versus placebo in another study were
studied (52.8% versus 43.5%, P=0.003).
Here, 9.4% of patients obtained relief
greater than placebo.35
Venlafaxine-XR was similar to
escitralopram and citalopram (P=0.03).35
Treatment of the elderly in the primary
care setting under the monoamine theory
reveals no relief of symptoms versus
placebo. In the elderly (79.6 years,
SD=4.4, N = 174), it was concluded that
citalopram, “…was not more effective
than placebo for the treatment of
depression…”27 In treatment
of depression in patients over 60 years
old with a mean age of 68 years old,
“Escitalopram treatment was not
significantly different from placebo
treatment” (N = 264).29
Depression treatment of children and
adolescents ages 7 to 17 (N = 174) with
citalopram, under a double blind 20 mg
per day, 40mg per day option, found 24%
of patients treated with placebo showed
improvement versus 36% of patients
taking citalopram.28
Other
studies of other reuptake inhibitors
revealed similar results.50, 51,
52, 53, 54, 55
Reuptake inhibitors are effective in
treating other disorders than those for
which they were initially developed,
such as obesity, panic disorder,
anxiety, migraine headaches, ADHD/ADD,
premenstrual syndrome, dementia,
fibromyalgia, psychotic illness,
insomnia, obsessive-compulsive disorder,
and bulimia/anorexia; yet not all drugs
that increase serotonin or catecholamine
transmission are effective when treating
depression. 1
Treatment with reuptake inhibitors is
based on the monoamine theory, which
does not explain why most subjects
studied achieve results no better than
placebo and why treatment is much less
efficacious in the elderly. Neither
does it explain the efficacy of treating
other conditions. In sum, the mechanism
and corresponding medication for the
treatment of depression suggest there
may be more to the underlying
pathophysiology.
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