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Psychopharmacologic Treatment Strategies for Depression, Bipolar Disorder, and Schizophrenia

Ira D. Glick, MD; Trisha Suppes, MD, PhD; Charles DeBattista, MD; Rona J. Hu, MD; and Stephen Marder, MD
[+] Article and Author Information

From Stanford University School of Medicine, Stanford, California; University of Texas Southwestern Medical Center, Dallas, Texas; and University of California, Los Angeles, Los Angeles, California.


Grant Support: The authors have received financial and/or research funding support from various sources, including the following manufacturers of drugs that may be discussed in this manuscript: Abbott Laboratories, Zeneca, Eli Lilly, Pfizer, Janssen, Novartis, SmithKline Beecham, Parke-Davis, Glaxo Wellcome, Bristol-Meyers Squibb, Forrest Laboratories, Scios, Wyeth-Ayerst, Organon, and Pharmacia Upjohn.

Requests for Single Reprints: Ira D. Glick, MD, Stanford University School of Medicine, 401 Quarry Road, Suite 2122, Stanford, CA 94305-5723; e-mail, iraglick@stanford.edu.

Current Author Addresses: Dr. Glick: Stanford University School of Medicine, 401 Quarry Road, Suite 2122, Stanford, CA 94305-5723.

Dr. Suppes: Bipolar Disorder Clinic, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9070.

Dr. DeBattista: Stanford University School of Medicine, 401 Quarry Road, Suite 2137, Stanford, CA 94305.

Dr. Hu: Stanford University School of Medicine, 401 Quarry Road, Suite 2114, Stanford, CA 94305.

Dr. Marder: West Los Angeles Veterans Affairs Medical Center, MIRECC 210A, 11301 Wilshire Boulevard, Los Angeles, CA 90072-1003.


Ann Intern Med. 2001;134(1):47-60. doi:10.7326/0003-4819-134-1-200101020-00013
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Patients with major psychiatric illnesses are often treated first, and sometimes exclusively, by family physicians and internists. Because the diagnosis and treatment of these disorders have changed profoundly in two decades, it may be difficult for specialists outside of psychiatry to keep informed (13). This, in turn, could lead to underdiagnosis and undertreatment. We therefore provide an updated synopsis for three important psychiatric disorders: major depression, bipolar disorder, and schizophrenia. Much of this information is not covered in consensus guidelines (46) or comprehensive reviews of these disorders (7), which are circulated minimally outside psychiatry and are not usually followed even when available (8).

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Figure 1.
Strategies for the treatment of major depressive disorder without psychotic features.

ECT = electroconvulsive therapy; MAOI = monoamine oxidase inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant. *Consider TCA or venlafaxine if not tried. Reproduced from J Clin Psychiatry. 1999;60:142-56.

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Figure 2.
Strategies for the treatment of major depressive disorder with psychotic features.

ECT = electroconvulsive therapy; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant. Reproduced from J Clin Psychiatry. 1999;60:142-56.

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Figure 3.
Strategies for the treatment of manic/hypomanic episodes.

CBZ = carbamazepine; DVP = divalproex sodium; ECT = electroconvulsive therapy. Reproduced from Journal of Practical Psychiatry and Behavioral Health. 1999;5:142-8.

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Figure 4.
Strategies for the treatment of major depressive episodes.

AD = antidepressant; AD-1 = bupropion SR or selective serotonin reuptake inhibitor; AD-2 = venlafaxine or nefazodone; ECT = electroconvulsive therapy; MAOI = monoamine oxidase inhibitor. Reproduced from Journal of Practical Psychiatry and Behavioral Health. 1999;5:142-8.

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Figure 5.
Strategies for the treatment of psychosis.

ECT = electroconvulsive therapy. Reproduced from J Clin Psychiatry. 1999;60:649-57.

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