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British Medical Bulletin 52:539-555 (1996)
© 1996 The British Council

research-article

Advances in psychopharmacology: mood disorder and dementia

P J Cowen

University Department of Psychiatry, Littlemore Hospital Oxford, UK

Abstract

Recent years have seen the introduction of several new antidepressants, many of which have selective effets on serotonin (5-HT) pathways. In most patients these drugs are as effective as traditional tricyclic antidepressants and are somewhat better tolerated. In the most severe depressive disorders, however, drugs such as clomipramine, that produce potent inhibition of both 5-HT and noradrenaline reuptake may be more effective. Lithium is increasingly used in the treatment of reistant depression but its role in the short-term management of mania is less certain because of the increased risk of relapse on sudden discontinuation. In the treatment of mania and prophylaxis of bipolar disorder, carbamazepine and valproate are alternatives to lithium. In dementia, the cholinesterase inhibitor, tacrine, produces worthwhile improvement in about 40% of patients able to tolerate adequate doses. There is concern about adverse effects of antipsychotic drugs in patients with dementia, particularty those with lewy body disease.


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