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EDITORIALS: ALEX J. MITCHELL Two-week delay in onset of action of antidepressants: new evidence The British Journal of Psychiatry 2006; 188: 105-106 [Abstract] [Full text] [PDF]

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call a spade a spade

David H Yates   (8 February 2006)

Early onset of action of anidepressants-possible mechanisms

RAJESH JACOB   (10 February 2006)

call a spade a spade 8 February 2006
David H Yates, psychiatrist retd Send letter to journal: Re: call a spade a spade mica{at}didgy.freeserve.co.uk David H Yates	The use of the general and undefined term anti-deprssant is becoming common, as though they are all the same in chemical category, and worked in the same way. The practice in non clinical accounts obscures the information intended.There, the anti-depressant referred to is one or other of the SSRI drugs. A failure is put down to a failure of all anti deprssant medication, when often, the older tri-cyclic drugs have not been tried, only a successive variation in the SSRI group In journals about psychiatry the term anti-depressant on it's own, should not be acceptable, and should be be replaced, at least by the separation into what are generally accepted as being in different categories = tri- cyclic, ssri, etc It was certainly true that those put on the tri-cyclic medications were expected to wait two weeks before they felt any particular benefit. This was often to encourage a proper take up in the face of initial side- effects. But it was a clinical experience also There was not such a clear experience for the MAO inhibitor class. As the SSRI medications were, and are, often started by General Practitioners I expect they tended to follow advice in letters from the good old bad old times before the SSRI drugs were handed out to one and all
Early onset of action of anidepressants-possible mechanisms 10 February 2006
RAJESH JACOB, Consultant Psychiatrist Northamptonshire healthcare NHS Trust Kettering Community Mental Health Team Send letter to journal: Re: Early onset of action of anidepressants-possible mechanisms rajeshjacob2005{at}yahoo.co.uk RAJESH JACOB	I read with interest the article by Dr Alex Mitchell about the early onset of action of antidepressants. I can think of two possible explanations for this. Firstly is the high rate of placebo response in antidepressant trials which can be upto 60%. Non specific measures such as meeting with a doctor,having a detailed interview and assessment as well as taking medication by itself can lead to clinical improvement as well as better scores on self rating scales for depression. Secondly antidepressant response is dose response related.In unpublished data from my earlier institute,we compared 2 groups of patients diagnosed to have severe depression according to ICD-10 criteria. One group was given 150 mg of dothiepin on the first day itself while the other group was given twice weekly bilateral modified ECT.Both the groups at the end of first week showed no significant difference on the scores obtained on standardised depression rating scales ,while group 1 which had recieved 150 mg of dothiepin on the first day had more side effects which was expected. In most antidepressant trials,the therapeutic dosages is achieved only by about the second week,which could probably explain the delayed response . So one suggestion would be to achieve the therapeutic dosage much faster so as to achieve maximum clinical response. Dr Rajesh Jacob Consultant Psychiatrist Kettering Community Mental Health Team Clarendon House 8-12 Station Road Kettering NN15 7HH Phone 01536 313802 Fax 01536 313804