Vol 1 n° 1 - Bipolar Disorders
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Antidepressants are indicated in about 40 different disorders, including mood disorders, anxiety disor- ders, and other disorders. We propose to call these disorders    antidepressant-responsive    disorders (ARDs). We describe the clinical and biological cri- teria    that    differentiate    the    antidepressants. Although antidepressants share the same clinical efficacy in most ARDs, the configuration of adverse drug reactions varies widely. The recent antide- pressants should be preferred to the tricyclic anti- depressants as first-line treatment because of their lesser risk of severe adverse drug reactions. How- ever,  several  recent  antidepressants  have  been associated with severe complications such as the serotonin syndrome and the withdrawal syndrome. Patient characteristics should be included as a cri- terion to predict both unwanted and favorable effects. Mood and antidepressants lthough the symptoms and signs of depressive states are well described, the physiology of normal mood remains quite mysterious. Mood is the integration over time of the emotions that accompany our representation of our present and future situation in this world. However, mood is not just the resultant of this representation, it can also influ- ence the representation. Figure 1 shows an engraving by the French painter Le Brun, a protégé of King Louis XIV. Le Brun was interested in the ways people expressed their feel- ings and emotions and produced numerous portraits on this theme. To accompany his depiction of extreme despair, he wrote his definition of severe depression (our translation): “Despair stems from the belief that we are not getting what we long for, and has the consequence that we lose even what we have got.” Typifying a totally opposite expression of mood, the contemporary American artist Jenny Holzer once wrote: “In a dream, you saw a way to survive and you were full of joy.”  These artists, and many others, reflected in their works their understanding of the interactions between cog- nition and emotion in the construct of human thinking. In simpler terms, we may state that every sentient being has two major goals: to experience pleasure and avoid pain. Mood can be viewed as an indicator of the success in achiev- ing these goals. But mood is a composite higher brain func- tion; it includes memory, programming, primary and sec- ondary  emotions,  as  well  as  a  huge  array  of  beliefs concerning the physical and psychological worlds. The main characteristic of psychotropic drugs is that they influence higher brain functions; by doing so, they also improve the symptoms and signs of psychiatric disorders. Like all other pharmacological agents, psychotropics exert their beneficial effects by inducing a disequilibrium in physiological systems. However, this disequilibrium proves to be useful because the system was not functioning prop- erly to start with. Antidepressants (ADs) are medications that modify mood, in the same manner as diuretics are medications that modify the circulating blood compart- ment. While the links between arterial hypertension and the physiology of the circulating blood compartment (elec- trolyte metabolism, vascular muscle tone, cardiac output, and mental stress) are well understood, the same cannot be P h a r m a c o l o g i c a l   a s p e c t s 4 Are all antidepressants alike? Pierre Schulz, MD A From:  the Clinical Psychopharmacology Unit, Department of Psychiatry, Geneva University Hospital, Switzerland Address for correspondence: Prof Pierre Schulz, Head of Clinical Psychopharmacology Unit, Department of Psychiatry,
Geneva University Hospitals (HUG),
Chemin du Petit-Bel-Air 2, CH-1225, Chêne-Bourg, Geneva, Switzerland
E-mail: schulz-pierre@diogenes.hcuge.ch Pierre SCHULZ Keywords: antidepressant; classification; mode of action; efficacy; side effect