BOOK REVIEW
Use of antidepressants in the medical context
Uso de antidepressivos no contexto médico
Rogério Göttert Cardoso
Psychiatrist. Forensic psychiatrist, Instituto Psiquiátrico Forense, Porto Alegre, RS, Brazil. Graduate student, Ethics and Education in Human Rights, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. rogeriogottertc@uol.com.br
Carlos Alberto Crespo de Souza, Mauro Barbosa Terra, Vera Lúcia Bidone Lopes (editors)
São Caetano do Sul, Yendis, 2011
With a foreword by Prof. Paulo Roberto Zimmermann, the above-mentioned book culminates the experience acquired over more than 20 years with consultation-liaison psychiatry by the three book editors and the 13 authors. The book discloses to the readers part of the knowledge acquired in the authors'work with patients treated at the nursing room at Irmandade Santa Casa de Misericórdia de Porto Alegre, in southern Brazil. As part of this arduous, complex, continuous chore, a high rate of antidepressant use was identified in association with the following specialties: anesthesia/surgery, cardiology, plastic surgery, dermatology, chronic pain treatment, endocrinology, gynecology/obstetrics, nephrology, oncology, pediatrics, pulmonology, coloproctology, and urology. This "wide spectrum" - let us put it that way - of the use of antidepressants motivated the authors to undertake a broad and detailed study, the results of which are brilliantly described in Uso de antidepressivos no contexto médico (in English, Use of antidepressants in the medical context).
The book starts by describing the history of antidepressants, their uses, mechanisms of action, and side effects (including drugs indicated for use and those requiring dose adjustment or even drug discontinuation/replacement). The text goes on to cover recent advances in pharmacology, in the search for drugs with different action profiles, so that their effects can be adjusted to each patient. Finally, the consequences of polypharmacy and pharmacological interactions are also addressed.
Some interesting descriptions include 1) the peculiar case of an anesthetist who had to discontinue antidepressants in some patients before surgery, followed by a description of the interactions between these drugs and currently used anesthetic agents and a discussion of other relevant issues in this medical specialty; 2) the case of a cardiologist dealing with depressive symptoms that are secondary to cardiac conditions, underscoring the influence of psychopathology on increased morbidity and mortality after cardiocirculatory events, with a focus on how the use of antidepressants could contribute to bringing relief and improvement to these patients; 3) finally, the concerns of plastic surgeons and their quest for well-being through esthetics, emphasizing the need to analyze patients'desires in the preoperative period (not rarely is their need for "surgical repair" motivated by a need for "emotional and affective repair").
The authors also address dermatological aspects from the point of view of "the skin that the sick live in," exploring frequent pathologies and their interface with psychiatry, as well as the benefits - sometimes side effects - of antidepressants in this context.
One of the syndromes frequently diagnosed in clinical practice is chronic pain, including underlying conditions that cause pain symptoms. The use of analgesics and their synergy with antidepressants have been extremely useful in the management of chronic pain (in spite of the complexity involved in their use). This application of antidepressants is discussed in detail, considering both their indications and the caution needed in their use, especially in view of occasional antagonisms or the potentiation of adverse effects.
Endocrine disorders and their psychic manifestations, as well as antidepressant-related sequelae, are described and studied using optimal approaches. Guidelines are provided regarding the best moment to start treatment whenever the use of antidepressants is indicated.
Specifically among women, the authors describe the psychopathology of hormonal cycles and gestation, as well as when - and at what doses - antidepressants can help these women in this stage of their lives.
In nephrology services, specialists estimate that, by 2020 (eight years from now), depression will be the main cause of years of life lost. They establish correlations between clinical comorbidities, including nephrological conditions, and the important role of antidepressants in the global management of these patients, including aspects related with dialysis and kidney transplantation.
Finally, in the field of oncology, the authors address the technical issues of the use of antidepressants in the global treatment of cancer. Also, with great sensitivity and tact, they explore the emotional issues resulting from the suffering caused by these diseases.
The specialties investigated also include pediatric pathologies, with a focus on the difficulties involved in the use of antidepressants in children, especially as a result of the scarcity of studies in this population. The authors remind us, for example, that about one-fourth of the adults diagnosed with depression refer the occurrence of the first episode during adolescence - clinical situations not always diagnosed and therefore often left untreated.
In pulmonology, the worsening of asthma and chronic obstructive pulmonary disease as a result of depressive and/or anxiety symptoms has long been recognized. Notwithstanding, the authors acknowledge that these aspects may not always be noticed by the physician, and consequently will not be considered in therapy. Among the many benefits of antidepressants in the field of pulmonology, their use in smoking cessation therapies and the improved quality of life - and reduced morbidity and mortality - associated with this measure among smokers deserves special mention. The pharmacological interactions between antidepressants and the pulmonological therapeutic arsenal are also discussed.
The authors underscore the potential benefits of the use of antidepressants and also of psychotherapeutic approaches in coloproctological patients. Finally, with regard to urological conditions, psychotropic drugs can either help in the relief and treatment of sexual dysfunction and urinary incontinence or cause their worsening, which requires a detailed knowledge of these drugs (and especially of antidepressants) on the part of urologists.
Last, but not least, if on the one hand the authors of Uso de antidepressivos no contexto médico explicitly underscore the importance of drugs in general and of antidepressants in particular - as well as the caution needed in their use -, on the other hand they do not ever neglect the therapeutic foundations laid by the doctor-patient relationship, preserving its fundamental role in the context of medicine, both for doctors and, of course, for patients.
Submitted Jul 05 2012, accepted for publication Aug Jul 10 2012.
No conflicts of interest declared concerning the publication of this review.
Publication Dates
-
Publication in this collection
18 Oct 2012 -
Date of issue
Sept 2012
