ADVANCES IN PSYCHOPHARMACOLOGY - MOOD DISORDERS AND DEMENTIA

Recent years have seen the introduction of several new antidepressants , many of which have selective effects on serotonin (5-HT) pathways. I n 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 produc e potent inhibition of both 5-HT and noradrenaline reuptake may be mor e effective. Lithium is increasingly used in the treatment of resistan t depression but its role in the short-term management of mania is les s certain because of the increased risk of relapse on sudden discontin uation. 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 improvemen t in about 40% of patients able to tolerate adequate doses. There is c oncern about adverse effects of antipsychotic drugs in patients with d ementia, particularly those with Lewy body disease.