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Anxiety-Antidepressant Medications
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One more word on feeding tubes
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ANXIETY MEDICATIONS
(written for Parkinson's)

Many persons with PD are aware of anxiety as part of their illness. This may be present with or without depression. Some individuals notice anxiety in the early stages of their disease, and note that it lessens with the introduction of effective dopaminergic medications.

Chronic disabling anxiety can be difficult to treat effectively with medications. Some antidepressant drugs have anti-anxiety
effects, and can be beneficial.
 
Benzodiazapine drugs, such as diazepam (Valium®), are in this classification. These medications must be used with caution because there is a tendency to increase the dose over time, and over-sedation can be a problem.
 
However, many patients with PD can benefit from these medications in small doses. In addition to reducing anxiety, benzodiazepines can help
alleviate other Parkinson symptoms such as dystonia (muscle cramping), involuntary dyskinetic movements, and insomnia. In situations that call for a longer-acting anxiolytic benefit, a medication called clonazepam (Klonopin®) is sometimes useful.

EXAMPLES OF DRUGS USED TO TREAT ANXIETY

diazepam (Valium®)
lorazepam (Ativan®)
clonazepam (Klonopin®)
clorazepate (Tranxene®)
alprazolam (Xanax®)
buspirone (Buspar®)

As with many other medications, this class of drugs can have side effects such as drowsiness, ataxia (unsteady gait), confusion, lethargy and memory impairment.
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From AskJeeves.com
 
Antidepressants
Non-addictive and non-euphoric, antidepressants are commonly prescribed for treating depression. Just as aspirin eases the symptoms of a headache without curing it, psychotherapeutic drugs do not cure mood disorders, though they do lessen the mentalpain, helping the individual to get on with life.

In general, antidepressants work by altering  neurotransmitters - most commonly, serotonin, norepinephrine and dopamine. In 60 to  80% of people who take antidepressants as directed for several months, there is a  significant improvement in mood.
 
Though highly effective, antidepressants commonly take  2 to 4 weeks before their full effect is evident.

It is often necessary to test several  antidepressants in various dosages before settling on the one that is best suited to the  individual.
 
Antidepressants may cause side effects from dry mouth and fatigue  to loss of sexual interest and weight fluctuations.

Any person who is using an antidepressant medication should consult a physician regularly The best outcomes result from a combination of antidepressant medication and counseling or psychotherapy (talk therapy).

For more specific information on antidepressants, consult a family doctor or mental health professional.

Side Effects from Commonly Prescribed Antidepressants

Aventyl (nortriptyline):
dry mouth; constipation; weakness-fatigue; tremors
Effexor (venlafaxine):
nausea; headache; sleepiness; dry mouth; insomnia; constipation
Elavil (amitriptyline):
dry mouth; drowsiness; weight gain; constipation; sweating
Nardil (phenelzine):
dry mouth; insomnia; increased heart rate; lowered blood pressure, sedation; over stimulation
Norpramin (desipramine):
dry mouth; increased pulse; constipation; reduced blood pressure
Pamelor (nortriptyline):
dry mouth; constipation; weakness-fatigue; tremors
Parnate (tranylcypromine):
 dry mouth; insomnia; increased pulse rate; lowered blood pressure; over stimulation; sedation
Paxil (paroxetine):
decreased sexual interest and/or problems achieving orgasm, nausea; sedation; dizziness, insomnia
Prozac (fluoxetine):
decreased sexual interest and/or problems achieving orgasm; nausea; headache; nervousness; insomnia; diarrhea
Sinequan (doxepin):
dry mouth; sedation; weight gain; lowered blood pressure, constipation, sweating
Tofranil (imipramine):
dry mouth, reduced blood pressure, constipation, difficulty with urination
Wellbatrin (bupropion):
agitation; weight loss, dizziness; decreased appetite
Zoloft (sertraline):
decreased sexual interest and/or problems achieving orgasm; nausea; headache; diarrhea; insomnia; dry mouth; sedation

Lithium
The most commonly prescribed medication for bipolar or manic disorders, lithium evens out the mood swings between high and low. While lithium diminishes severe manic symptoms,  it takes 5 to 14 days to be effective, and it may be months before the condition is fully controlled.
 
Anti-psychotic drugs may be used in conjunction with lithium in the initial stages of treatment. As well, antidepressants may be necessary during depressive phases.

Electroconvulsive Therapy (ECT)
When antidepressants prove ineffective, ECT is an option. Once known as "shock therapy", ECT is safe and effective, but has been given a bad name because of films and books like 'One Flew Over the Cuckoo's Nest'.
 
Many people who could benefit from ECT don't consider it because of outdated or misinformed perceptions. They should. In treating severe
depression, ECT has a success rate of 80 to 90%.

Herbal Medicines and Alternative Therapies
For many people, herbs such as St. John's Wort and ginko have proven beneficial in alleviating the symptoms of depression.
 
Like any other medication that is strong enough to be effective, these herbs can have unpleasant side effects, and should only be used
under medical supervision. St. John's Wort, for instance, should never be taken by anyone who is already on antidepressant medication, or by a woman who is pregnant, or suspects that she may be pregnant, or who hopes to conceive while being treated for depression.

The Potential Harm of Herbs
Although most physicians and patients will acknowledge that prescription and over-the-counter medications have potentially harmful effects, many people are not aware of the potential harmful effects of some herbs used in complimentary or alternative medicine:

Sassafras
used as a tonic or painkiller - can cause vomiting and paralysis; there are also reports of death from taking a single teaspoon.
Coltsfoot
used as a cough suppressant - may cause cancer and liver problems.
Laetrile
used to combat cancer - is potentially poisonous.
Lobella
used for asthma - can cause vomiting and diarrhea and has been declared
a poisonous plant by the FDA.
Mistletoe
used to combat cancer - may be fatal in children after 1-2 berries.

Further drug interactions with St. John's wort
Taking St. John's wort has been shown to interfere with the blood thinning properties of coumadin and with medications used after transplant surgery.
 
If you or your care recipient have had an organ transplant (e.g., heart or kidney) and are on cyclosporin, St. John's wort may counteract the activity of the cyclosporin and increase the risk of organ rejection.
 
Similarly, St. John's wort may lessen the effects of coumadin resulting
in the blood not being thin enough while taking this medication. This "non-thinning" affect on the blood may increase the risk of certain conditions like strokes and blood clots in the lungs
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Antidepressants Linked To Sexual Dysfunction More Often Than Expected
NEW ORLEANS (Reuters Health) - Nearly 40% of people taking
antidepressants experience sexual problems after beginning their
medication, Dr.  Anita Clayton, associate professor and vice
chair of psychiatric medicine at the University of Virginia
Health Systems in Charlottesville, Virginia, told participants
here at the annual meeting of the American Psychiatric
Association.  This rate is nearly twice what the patients'
physicians predicted.

Certain antidepressants were more likely to be associated with sexual dysfunction. Compared with bupropion SR (Wellbutrin), sexual problems were six times more likely to be reported by subjects on venlafazine XR (Effexor), five times more likely in patients on paroxetine (Paxil) or sertraline (Zoloft), and four times more common in patients on fluoxetine (Prozac).
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Antidepressants That Increase Serotonin Reuptake Inhibition Raises Risk of GI Bleeding
WESTPORT, CT (Reuters Health) Sept 20 - Antidepressants that result in a high inhibition of serotonin reuptake further increase the risk of upper gastrointestinal bleeding among older adults who are already at risk, Canadian investigators report in the British Medical Journal for September 22.
Dr. van Walraven emphasized that physicians need to take into account overall tolerance and effectiveness when choosing an antidepressant for their elderly patients. "This is just another factor they need to consider when prescribing," he added.
============================

Paroxetine (Paxil) Effective - Adolescent Depression

What's interesting, to me, is the following were excluded from
this study: diagnosis of bipolar, schizoaffective, eating, alcohol or substance use, obsessive-compulsive, autism/pervasive developmental or
organic brain disorders.

========================
Landmark Study Finds Paroxetine Effective Treatment for Adolescent Depression

Clinical Implications

"Major depression in adolescents is an increasingly recognized clinical problem that is remarkably under-studied," say the authors. With very few well-controlled studies of SSRIs, the present study findings are "there-fore relevant to clinicians who are faced with treatment decisions for depressed adolescents and a relative paucity of data guiding therapeutic choice."

Keller et al. conclude that "SSRIs are the medications of choice for the treatment of major depression in adolescents because they are the only agents that have been shown to be efficacious in this population; they have a safer side-effect profile than other antidepressants, particularly in overdose; and they can be administered once daily."
==============================================

Venlafaxine Efficacious for Major Depression
A DGReview of :"Treatment of major depression with venlafaxine"
06/13/2001

Venlafaxine is both efficacious and safe in the treatment of major depression. Greek researchers conducted a clinical trial of the drug, testing 50 patients diagnosed with major depression under Diagnostic and Statistical Manual of Mental Disorders IV criteria.

This was a first depressive episode for 40 percent of participants. A total of
30 percent of the patients were 65 years or older and 60 percent were women.

Drug dosage was adjusted by patient age. For those younger than 65 years, dosage was 100 to 150 milligrams per day. For those 65 years and older, dosage was 75 to 100 mg/d.

All patients received drug therapy for eight weeks. They were also instructed in behaviour-cognitive techniques. Instruction included activity programming and satisfaction techniques.

Researchers assessed the participants using three instruments: the Hamilton Depression Scale, the Hamilton Anxiety Scale and the Mini Mental State Examination.

They note that 10 percent of participants discontinued treatment because of adverse events. These included nausea, headache, somnolence, dizziness, insomnia, dry mouth and malaise. Four percent stopped drug therapy because they reported no improvements.

Investigators report: "A total of 79 percent of those who completed their treatment showed improvement at the end of the eighth week; 65 percent were clinically improved at the end of the fourth week, and 75 percent at the end of the sixth week.

"Higher rates of clinical improvement seen in our study were attributed to the use of behaviour-cognitive techniques not applied in other studies."

Encephalos: Archives of Neurology and Psychiatry, 2001; Vol. 38 (2), April-June. "Treatment of major depression with venlafaxine"
Source:  Doctor's Guide