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Trends in Psychiatry and Psychotherapy

versão impressa ISSN 2237-6089

Trends Psychiatry Psychother. vol.35 no.2 Porto Alegre  2013 



O uso de antidepressivos na clínica médica


The use of antidepressants in medicine



Carlos Alberto Crespo de Souza (editor)
Porto Alegre, Sulina, 2011


Lisieux Elaine de Borba Telles

MD, PhD. Forensic psychiatrist, Instituto Psiquiátrico Forense Dr. Maurício Cardoso, Porto Alegre, RS, Brazil. Supervisor, Forensic Psychiatry Residency, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil






The high prevalence of depressive disorders requires physicians of the different specialties to get into contact with patients who have this pathology and its different comorbidities. Appropriate treatment of this disorder initially requires a correct diagnostic evaluation and the rational prescription of medications.

According to a very appropriate statement by Prof. João Romildo Bueno in the Preface of the book O uso de antidepressivos na clínica médica, we should be alert against transforming the use of pharmaceutical drugs into commonplace. The author also stated that works should be written about the correct use of antidepressant substances. The book here reviewed has appeared to satisfy this need. It was published by the Sulina publishing house in 2011, with 13 chapters written by the organizer and well-known colleagues from different national academic centers. In addition to their technical quality, the chapters have broad, up-to-date reviews that are very useful for physicians working in primary care, residents, specialists in different fields of medicine, and experienced psychiatrists.

In Chapters 1 and 2, which are rather extensive, the organizer describes the history and development of the use of these drugs, as well as practical information about their use, dosage, interactions and contraindications, discontinuation syndrome, risk of cholinergic effects, and toxicity. The use of antidepressants at different times of the life cycle, in different medical specialties, and in the most prevalent pathologies is described, and topics of clinical relevance to modern medicine are discussed, always with clear, easily understandable language.

In Chapters 3 and 4, written by Carlos Alberto Crespo de Souza, pharmacogenomics and the HapMap Project are discussed in a logical and didactic way, making it easy for future psychiatrists to understand the use of genotyping. According to the reading of these texts, this future is very near to us, and will enable genetic testing before the use of antidepressants. This will allow a more appropriate choice and less adverse effects.

Chapter 5, by Gibsi Maria Possapp Rocha, focuses on the use of antidepressants in adolescence. She alerts to the early onset of signs of depression and to the comorbidities present in this phase, such as anxiety disorders, psychoactive substance abuse, and disruptive disorders. She also calls the reader’s attention to the risk of suicide at different times over the course of the disorder and its treatment. The chapter also contains a review of the most appropriate drugs for this period in life.

In Chapter 6, the organizer discusses the use of antidepressants in gastroenterology. The most prevalent "functional diseases" are studied one by one, and the interface between gastroenterology and psychiatry is carefully reviewed. Other topics of interest are presented, such as the adequate use of antidepressants in patients with liver disease and inflammatory bowel disease, side effects of antidepressants on the digestive tract, drug interactions and discontinuation in such situations.

Chapter 7, written by Mauro Barbosa Terra, discusses antidepressants in chemical addictions. In this chapter, the reader finds a complete review of interactions and beneficial effects of these drugs on both dependence on different psychoactive substances and frequent comorbid pathologies.

The authors of Chapter 8, Alfredo Cataldo Neto, Aroldo Ayud Dargél, Cristiano Tschieldel Belém da Silva, and Eduardo Lopes Nogueira, writing about the use of antidepressants in the elderly, highlight the difficulties involved in diagnosing depression in this phase of the life cycle; they also discuss the frequent use of multiple drugs and subtherapeutic doses of antidepressants. They provide readers with a broad review of the conscientious use of these drugs.

Another vulnerable population that deserves attention is organ transplant patients, in whom the long duration of the disease, combined with uncertainties about the future, contribute to the onset of depression. Treatment with drugs is very sensitive in these cases and requires care and adaptation to the specific type of organ transplanted. These items are dealt with in Chapter 9 by Alcir Tadeu Giglio.

The use of antidepressants in medical situations that are complex due to difficulties performing diagnosis and/or treatment, e.g., patients with chronic pain/fibromyalgia or eating disorders, is meticulously described in Chapter 10 by Rogério Gottert Cardoso and in Chapter 11 by the organizer and Guilherme Modkovski. In the latter chapter, the presence of comorbidities and physiological changes resulting from pathological eating behaviors and their effects on the use of antidepressants are discussed, with emphasis on the extra care needed in these cases, such as the performance of laboratory tests to follow vital functions.

Chapter 12, written by the organizer, together with Miguel Abib Adad and Luciane Miozzo, is dedicated to a significant expression of human behavior: sexuality. This chapter studies antidepressants and sexual dysfunction, with an interesting investigation of the characteristics that distinguish human sexuality from that of animals, the influences of culture, religion, and even politics on the organization of rules and standards regulating this construct. Other aspects are also explored, e.g., the history of the study of sexuality, its evolution among humans, sexual cycle and its physiology, hormones responsible for physiological effects, definition of sexual dysfunction, determining factors, and therapeutic measures available at present.

Finally, but not less important, the organizer writes a few comments and conclusions about the texts presented, concluding that the book was conceived to become part of modern medicine, sharing recent studies and research, so that it will provide our fellow physicians from different related specialties with alternatives for a better understanding and use of up-to-date knowledge, while at the same time providing valuable contributions found in the history of medicine.

I wish you all good reading, certain that this book will provide knowledge, up-to-date information, and an incentive for good daily medical practice.



Lisieux Elaine de Borba Telles

Submitted Jan 10 2013, accepted for publication Jan 28 2013.



No conflicts of interest declared concerning the publication of this review.
Financial Support: none.

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