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SSRIs should be the first choice for treatment 
of depression and bipolar disorders

By Dr. Khalid Ishaq

COVENTRY (UK): Dr. Hamish McAllister Williams in his presentations at the Midland Psychiatric Research Group meeting highlighted the importance of SSRIs and opined that they should be the first line of drugs in the management of depression and bipolar disorders rather than tricyclic antidepressants (TCAs) which have lot of side effects. Out of the tricyclic antidepressants lofapramine is relatively safer. The scare which was thriving in UK about venlafaxine and its side effects has been modified by the NICE guidelines. This antidepressant is considered safer than other agents.

However, he opined that ECG of all patients should be done and they should all be monitored regularly.  If the patient has a history of hypertension, then such patients should be treated by the cardiac physicians for their hypertension, then the use of SSRIs is considered safe in these patients. As regards management of bipolar disorders, it is becoming increasingly more acceptable to prescribe atypical neuroleptics not only during manic phase but also severe depressive episodes with psychotic symptoms as well as during the maintenance period. These agents are increasingly replacing lithium and carbamezapine as well as sodium valporate. However, in some cases it is also being used an adjunct therapy with these drugs.

Carbamezapine, he opined, was losing its popularity because of its potential side effects while some people are also questioning its efficacy in new research studies. On the other hand lamotrigene is being used more and more in bipolar disorders. It seems to be especially more useful in recurrent manic episodes. Lithium is already known to be more beneficial in recurrent depressive episodes. New neuroleptics, Prof. Williams remarked, have fewer side effects and new research favours the use of atypical antipsychotic in maintenance dose. Psychiatrists in America and North America, Prof. Williams said, give anti depressants for eight weeks after relapse of bipolar disorders which is not the practice in United Kingdom. Here majority of clinicians keep patients on small dose of antidepressants for longer time, he added.