Merck manual duloxetine

Sometimes a combination of the two, known as cognitive-behavioral therapy, is used. The theoretical basis of behavioral therapy is learning theory, which says that abnormal behaviors are due to faulty learning. Cognitive therapy helps people identify distortions in thinking and understand how these distortions lead to problems in their lives. For example, people may think in an all-or-nothing way "if I am not a total success, I am a complete failure".

The premise is that how people feel and behave is determined by how they interpret experiences. Through the identification of core beliefs and assumptions, people learn to think in different ways about their experiences, reducing symptoms and resulting in improvement in behavior and feelings. It focuses on the following:. Conflicts that arise when people have to fill roles that differ from their expectations such as when a woman enters a relationship expecting to be a stay-at-home mother and finds that she must also be the major provider for the family.

The therapist teaches the person to improve aspects of interpersonal relationships, such as overcoming social isolation and responding in a less habitual way to others. Psychoanalysis is the oldest form of psychotherapy and was developed by Sigmund Freud in the first part of the 20th century. Much of the focus is on helping the person understand how past patterns of relationships repeat themselves in the present.

The relationship between the person and the therapist is a key part of this focus. An understanding of how the past affects the present helps the person develop new and more adaptive ways of functioning in relationships and in work settings. Psychodynamic psychotherapy, like psychoanalysis, emphasizes the identification of unconscious patterns in current thoughts, feelings, and behaviors.

However, the person is usually sitting instead of lying on a couch and attends only 1 to 3 sessions per week. In addition, less emphasis is placed on the relationship between the person and therapist. Supportive psychotherapy, which is most commonly used, relies on the empathetic and supportive relationship between the person and the therapist. It encourages expression of feelings, and the therapist provides help with problem solving.

Problem-focused psychotherapy, a form of supportive therapy, may be used successfully by primary care doctors. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.

The Merck Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. This finding was first reported with SSRIs, but the risk probably does not differ among classes of antidepressants. The person's doctor should be notified if symptoms worsen after antidepressants are started or the dose is increased or for any reason.

Because having suicidal thoughts is also a symptom of depression, doctors may have difficulty determining what role antidepressants play in suicidal thoughts and behavior. Some studies cast doubt on the connection. Selective serotonin reuptake inhibitors SSRIs are now the most commonly used class of antidepressants.

SSRIs are effective in treating depression as well as other mental health disorders that often coexist with depression. Although SSRIs can cause nausea, diarrhea, tremor, weight loss, and headache, these side effects are usually mild or go away with continued use. Most people tolerate the side effects of SSRIs better than the side effects of heterocyclic antidepressants Heterocyclic including tricyclic antidepressants Agomelatine, a new type of antidepressant, is a possible treatment for major depressive episodes.

SSRIs are less likely to adversely affect the heart than heterocyclic antidepressants. However, a few people may seem more agitated, depressed, and anxious the first week after they start SSRIs or the dose is increased. These people, especially younger children and adolescents, may become increasingly suicidal if these symptoms are not detected and rapidly treated. People taking SSRIs and their loved ones should be warned of this possibility and instructed to call their doctor if symptoms worsen with treatment.

However, because people with untreated depression also sometimes complete suicide, people and their doctors must balance this risk against the risk of drug treatment. Also, with long-term use, SSRIs may have additional side effects, such as weight gain and sexual dysfunction in one third of people.

Some SSRIs, such as fluoxetine , cause loss of appetite. During the first few weeks after SSRIs are started, people may feel drowsy during the day, but this effect is temporary. Abruptly stopping some of the SSRIs may result in a discontinuation syndrome that includes dizziness, anxiety, irritability, fatigue, nausea, chills, and muscle aches.

Newer antidepressants are as effective and safe as SSRIs and have similar side effects. These drugs include. Norepinephrine - dopamine reuptake inhibitors such as bupropion. Serotonin modulators such as mirtazapine and trazodone. Serotonin- norepinephrine reuptake inhibitors such as venlafaxine and duloxetine. As may occur with SSRIs, the risk of suicide may be temporarily increased when these drugs are first started, and abruptly stopping serotonin- norepinephrine reuptake inhibitors may result in a discontinuation syndrome.

Heterocyclic antidepressants, once the mainstay of treatment, are now used infrequently because they have more side effects than other antidepressants. They often cause drowsiness and lead to weight gain. They can also cause an increase in heart rate and a decrease in blood pressure when a person stands called orthostatic hypotension Dizziness or Light-Headedness When Standing Up In some people, particularly older people, blood pressure drops excessively when they sit or stand up a condition called orthostatic or postural hypotension.

Mom's Rapid Response Saved Her. Infographics View All. Obstructive Sleep Apnea. Important: The authors, reviewers, and editors of this material have made extensive efforts to ensure that treatments, drugs, and discussions about medical practice are accurate and conform to the standards accepted at the time of publication. However, constant changes in information resulting from continuing research and clinical experience, reasonable differences in opinions among authorities, unique aspects of individual clinical situations, and the possibility of human error in preparing such an extensive text mean that other sources of medical information may differ from the information on this site.

The information on this site is not intended to be professional advice and is not intended to replace personal consultation with a qualified physician, pharmacist, or other health care professional. The reader should not disregard medical advice or delay seeking it because of something found on this site. Serotonin modulators have antidepressant and anxiolytic effects but do not cause sexual dysfunction.

Trazodone has caused priapism Priapism Priapism is painful, persistent, abnormal erection unaccompanied by sexual desire or excitation.

It is most common in boys aged 5 to 10 years and in men aged 20 to 50 years. The penis is composed It is most often given in to mg doses at bedtime to depressed patients with insomnia. The result is increased serotonergic function and increased noradrenergic function without sexual dysfunction or nausea. It has no cardiac adverse effects, has minimal interaction with drug-metabolizing liver enzymes, and is generally well-tolerated, although it does cause sedation and weight gain, mediated by H 1 histamine blockade.

These drugs eg, desvenlafaxine , duloxetine , levomilnacipran , venlafaxine , vortioxetine have a dual 5-HT and norepinephrine mechanism of action, as do tricyclic antidepressants Heterocyclic Antidepressants Several drug classes and drugs can be used to treat depression: Selective serotonin reuptake inhibitors SSRIs Serotonin modulators 5-HT2 blockers Serotonin-norepinephrine reuptake inhibitors However, their toxicity approximates that of selective serotonin reuptake inhibitors SSRIs.

Nausea is the most common problem during the first 2 weeks; modest dose-dependent increases in blood pressure BP occur with high doses. Discontinuation symptoms eg, irritability, anxiety, nausea often occur if the drug is stopped suddenly. Duloxetine resembles venlafaxine in effectiveness and adverse effects. By mechanisms not clearly understood, this class of drug favorably influences dopaminergic and noradrenergic function and does not affect the 5-HT system.

Bupropion is currently the only drug in this class. High doses can cause panic, schizophrenic-like symptoms, seizures, hyperthermia, hypertension Bupropion causes hypertension in a very few patients but has no other effects on the cardiovascular system. Bupropion can cause seizures in 0. Bupropion does not have sexual adverse effects and interacts little with coadministered drugs, although it does inhibit the CYP2D6 hepatic enzyme.

Agitation, which is common, is considerably attenuated by using the SR or XR form. This group of drugs, once the mainstay of treatment, includes tricyclic tertiary amines amitriptyline and imipramine and their secondary amine metabolites nortriptyline and desipramine , modified tricyclic, and tetracyclic antidepressants. Acutely, heterocyclic antidepressants increase the availability of primarily norepinephrine and, to some extent, 5-HT by blocking reuptake in the synaptic cleft.

Long-term use downregulates alpha-1 adrenergic receptors on the postsynaptic membrane—a possible final common pathway of their antidepressant activity.

Although effective, these drugs are now rarely used because overdose causes toxicity and they have more adverse effects than other antidepressants. The more common adverse effects of heterocyclics are due to their muscarinic-blocking, histamine-blocking, and alpha-1 adrenolytic actions. Many heterocyclics have strong anticholinergic properties and are thus unsuitable for older patients and those with benign prostatic hypertrophy Benign Prostatic Hyperplasia BPH Benign prostatic hyperplasia BPH is nonmalignant adenomatous overgrowth of the periurethral prostate gland.

Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary See also Constipation in Children.

No bodily function is more variable and All heterocyclics, particularly maprotiline and clomipramine , lower the threshold for seizures. These drugs inhibit the oxidative deamination of the 3 classes of biogenic amines norepinephrine , dopamine , 5-HT and other phenylethylamines. Their primary value is for treating refractory or atypical depression when selective serotonin reuptake inhibitors SSRIs , tricyclic antidepressants, and sometimes even electroconvulsive therapy Electroconvulsive therapy ECT Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities.

This effect is called the cheese reaction because mature cheese has a high tyramine content. MAOIs are used infrequently because of concern about this reaction. The lower dosage of the selegiline patch is considered safe to use without specific dietary restrictions, unless the dosage must be higher than starting levels a 6-mg patch. To prevent hypertension and febrile crises, patients taking MAOIs should avoid sympathomimetic drugs eg, pseudoephedrine , dextromethorphan , reserpine , and meperidine as well as malted beers, Chianti wines, sherry, liqueurs, and overripe or aged foods that contain tyramine or dopamine eg, fava or broad beans, yeast extracts, canned figs, raisins, yogurt, cheese, sour cream, soy sauce, pickled herring, caviar, liver, banana peel, extensively tenderized meats.