Categorising the behavioural toxicities of antidepressants. Proposals and requirements

Helping patients who say they cannot sleep. Practical ways to evaluate and treat insomnia

Why do some people spend most of the night tossing and turning while others drop off as quickly as a cat in the sun? There are many possible explanations for problems with falling and staying asleep and, sometimes, patients actually get a lot more sleep than they think they do. Each type of insomnia has its own set of symptoms, which can be used, along with appropriate diagnostic tools, to help in identification. In this article, Dr. Attarian describes differential diagnosis and summarizes the best treatment approaches to the common causes of insomnia.

Advantages and limitations of the concept of antidepressant therapy

The current availability of a range of effective treatments make it more than ever necessary for depression to be recognised. The emphasis of treatment has moved from acute episodes to the longitudinal course of affective disorders. In addition to Major Depressive Disorder, the need for treatment is now established in less severe variants, particularly Dysthymia; the same drugs are applicable, but should be part of a global strategy. In general, antidepressants have to be considered in relation to non-pharmacological treatment methods, of which the most important is ECT. A great variety of new drugs have been found to have antidepressant efficacy, but pharmacologically this action is not a specific or exclusive one. Side-effects have on the whole not been studied for long enough, or in depressed patients rather than healthy volunteers; there are marked variations between individuals in their reactions to different drugs. Co-morbidity is a frequent issue in the treatment of depression, particularly for the elderly. Since overall suicide rates have not fallen in many countries, the treatment particularly of Major Depressive Disorder and Bipolar Disorder needs to be strengthened.