96-414: A seizure is a sudden change in behavior, movement, and/or consciousness due to abnormal electrical activity in the brain . Seizures can look different in different people. It can be uncontrolled shaking of the whole body ( tonic-clonic seizures ) or a person spacing out for a few seconds ( absence seizures ). Most seizures last less than two minutes. They are then followed by confusion/drowsiness before
192-452: A second-line treatment for adult obsessive–compulsive disorder (OCD) with mild functional impairment, and a first-line treatment for those with moderate or severe impairment. In children, SSRIs are considered as a second-line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects. Sertraline and fluoxetine are effective in treating OCD for children and adolescents. Clomipramine ,
288-436: A TCA drug, is considered effective and useful for OCD. However, it is used as a second-line treatment because it is less well-tolerated than SSRIs. Despite this, it has not shown superiority to fluvoxamine in trials. All SSRIs can be used effectively for OCD. SNRI use may also be attempted, though no SNRIs have been approved for the treatment of OCD. Despite these treatment options, many patients remain symptomatic after initiating
384-461: A bite. Weakness of one limb or asymmetric reflexes are also signs a seizure just occurred. Presence of urinary incontinence or fecal incontinence also strongly suggests a seizure occurred. However, most people who have had a seizure will have a normal physical exam. Blood tests can determine if there are any reversible causes of the seizure (provoked seizures). This includes a complete blood count that may show infection. A comprehensive metabolic panel
480-1195: A cause that is temporary and reversible. They are also known as Acute Symptomatic Seizures as they occur closely after the injury. Unprovoked seizures do not have a known cause or the cause is not reversible. Unprovoked seizures are typically considered epilepsy and treated as epilepsy. Of those who have a seizure, about 25% have epilepsy . Those with epilepsy may have certain triggers that they know cause seizures to occur, including emotional stress, sleep deprivation, and flickering lights. Dehydration can trigger epileptic seizures by changing electrolyte balances. Low blood sugar, low blood sodium , high blood sugar , high blood sodium , low blood calcium , high blood urea , and low blood magnesium levels may cause seizures. Up to 9% of status epilepticus cases occur due to drug intoxication. Common drugs involved include antidepressants , stimulants ( cocaine ), and antihistamines . Withdrawal seizures commonly occur after prolonged alcohol or sedative use. In people who are at risk of developing epileptic seizures, common herbal medicines such as ephedra , ginkgo biloba and wormwood can provoke seizures. Systemic infection with high fever
576-458: A discussion between the patient and doctor. In children with one simple febrile seizure , starting anti-seizure medications is not recommended. While both fever medications ( antipyretics) and anti-seizure medications reduce reoccurrence, the harmless nature of febrile seizures outweighs the risks of these medications. However, if it was a complex febrile seizure, EEG should be done. If EEG is abnormal, starting prophylactic anti-seizure medications
672-402: A first seizure depends on many factors. If it was an unprovoked seizure with abnormal brain imaging or abnormal EEG, then it is recommended to start anti-seizure medication. If a person has an unprovoked seizure, but physical exam is normal, EEG is normal, and brain imaging is normal, then anti-seizure medication may not be needed. The decision to start anti-seizure medications should be made after
768-404: A mental health professional in the previous year. Several strategies are used in clinical practice to try to overcome these limits and variations. They include switching medication, augmentation, and combination. There is controversy amongst researchers regarding the efficacy and risk-benefit ratio of antidepressants. Although antidepressants consistently out-perform a placebo in meta-analyses,
864-523: A new drug and staying on the old medication: although 34% of treatment-resistant people responded when switched to the new drug, 40% responded without being switched. For a partial response, the American Psychiatric Association (APA) guidelines suggest augmentation or adding a drug from a different class. These include lithium and thyroid augmentation, dopamine agonists , sex steroids , NRIs , glucocorticoid -specific agents, or
960-459: A person has never had a seizure but anti-seizure medications are started to prevent seizures in those at risk. Following traumatic brain injury , anti-seizure medications decrease the risk of early seizures but not late seizures. However, there is no clear evidence that anti-seizure medications are effective at preventing seizures following brain surgery ( craniotomy) , a brain bleed, or after a stroke . Prevention of seizures from re-occurring after
1056-612: A person suffering from loss of energy and enjoyment of life would take a norepinephrine–dopamine reuptake inhibitor . The UK National Institute for Health and Care Excellence (NICE)'s 2022 guidelines indicate that antidepressants should not be routinely used for the initial treatment of mild depression, "unless that is the person's preference". The guidelines recommended that antidepressant treatment be considered: The guidelines further note that in most cases, antidepressants should be used in combination with psychosocial interventions and should be continued for at least six months to reduce
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#17328691846241152-474: A person's first seizure, they are legally not allowed to drive until they are seizure-free for a period of time. This period of time varies between states, but is usually between 6 and 12 months. They are also cautioned against working at heights and swimming alone in case a seizure occurs. Following a first unprovoked seizure, the risk of more seizures in the next two years is around 40%. Starting anti-seizure medications reduces recurrence of seizures by 35% within
1248-547: A phenomenon called publication bias or selective publication. Although this issue has diminished with time, it remains an obstacle to accurately assessing the efficacy of antidepressants. Misreporting of clinical trial outcomes and of serious adverse events, such as suicide, is common. Ghostwriting of antidepressant trials is widespread, a practice in which prominent researchers, or so-called key opinion leaders, attach their names to studies actually written by pharmaceutical company employees or consultants. A particular concern
1344-433: A placebo, while the other SNRIs are not considered particularly useful for this disorder as many of them did not undergo testing for it. As of 2008 , it is unclear if duloxetine and desvenlafaxine can provide benefits for people with social anxiety. However, another class of antidepressants called MAOIs are considered effective for social anxiety, but they come with many unwanted side effects and are rarely used. Phenelzine
1440-513: A potentially lethal hypertensive crisis . At lower doses, the person may only experience a headache due to an increase in blood pressure. In response to these adverse effects, a different type of MAOI, the class of reversible inhibitor of monoamine oxidase A (RIMA), has been developed. The primary advantage of RIMAs is that they do not require the person to follow a special diet while being purportedly effective as SSRIs and tricyclics in treating depressive disorders. Tricyclics and SSRI can cause
1536-620: A risk of causing epilepsy. Infection with the pork tapeworm , which can cause neurocysticercosis , is the cause of up to half of epilepsy cases in areas of the world where the parasite is common. Meningitis and encephalitis also carry the risk of causing long-term epilepsy as well. During childhood, well-defined epilepsy syndromes are generally seen. Examples include Dravet Syndrome , Lennox-Gastaut Syndrome , and Juvenile Myoclonic Epilepsy . Neurons function by either being excited or inhibited. Excited neurons fire electrical charges while inhibited neurons are prevented from firing. The balance of
1632-563: A second seizure. In children, the risk of seizure recurrence within the five years following a single unprovoked seizure is about 50%; the risk rises to about 80% after two unprovoked seizures. In the United States in 2011, seizures resulted in an estimated 1.6 million emergency department visits; approximately 400,000 of these visits were for new-onset seizures. Epileptic seizures were first described in an Akkadian text from 2000 B.C. Early reports of epilepsy often saw seizures and convulsions as
1728-540: A seizure. Some claim that seizure response dogs , a form of service dog , can predict seizures. Evidence for this, however, is poor. Cannabis has also been used for the management of seizures that do not respond to anti-seizure medications. Research on its effectiveness is ongoing, but current research shows that it does reduce seizure frequency. A ketogenic diet or modified Atkins diet may help in those who have epilepsy who do not improve following typical treatments, with evidence for its effectiveness growing. Following
1824-671: A short follow up after termination of treatment; non-systematic recording of adverse effects; very strict exclusion criteria in samples of patients; studies being paid for by the industry; selective publication of results. This means that the small beneficial effects that are found may not be statistically significant. Among the 21 most commonly prescribed antidepressants, the most effective and well-tolerated are escitalopram , paroxetine , sertraline , agomelatine , and mirtazapine . For children and adolescents with moderate to severe depressive disorder, some evidence suggests fluoxetine (either with or without cognitive behavioral therapy )
1920-437: A tool that allows people to rate their concern about common side effects of antidepressants. The tool ranks potential treatment options in a visual display that highlights the drugs with side effects of least concern to an individual. SSRI use in pregnancy has been associated with a variety of risks with varying degrees of proof of causation. As depression is independently associated with negative pregnancy outcomes, determining
2016-441: A treatment for social anxiety disorder , but their efficacy is not entirely convincing, as only a small proportion of antidepressants showed some effectiveness for this condition. Paroxetine was the first drug to be FDA-approved for this disorder. Its efficacy is considered beneficial, although not everyone responds favorably to the drug. Sertraline and fluvoxamine extended-release were later approved for it as well, while escitalopram
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#17328691846242112-521: Is a benzodiazepine , with most guidelines recommending lorazepam . Diazepam and midazolam are alternatives. It may be given in IV if emergency services is present. Rectal and intranasal forms also exist if a child has had seizures previously and was prescribed the rescue medication. If seizures continue, second-line therapy includes phenytoin , fosphenytoin , and phenobarbital . Levetiracetam or valproate may also be used. Starting anti-seizure medications
2208-462: Is a common cause of seizures, especially in children. These are called febrile seizures and occur in 2–5% of children between the ages of six months and five years. Acute infection of the brain, such as encephalitis or meningitis are also causes of seizures. Acute stroke or brain bleed may lead to seizures. Stroke is the most common cause of seizures in the elderly population. Post-stroke seizures occur in 5-7% of those with ischemic strokes. It
2304-476: Is a common disorder in which the central feature is excessively worrying about numerous events. Key symptoms include excessive anxiety about events and issues going on around them and difficulty controlling worrisome thoughts that persists for at least 6 months. Antidepressants provide a modest to moderate reduction in anxiety in GAD. The efficacy of different antidepressants is similar. Some antidepressants are used as
2400-529: Is a high treatment response heterogeneity. Some patients, that differ strongly in their response to antidepressants, could influence the average response, while the heterogeneity could itself be obscured by the averaging. Studies have not supported this hypothesis, but it is very difficult to measure treatment effect heterogeneity. Poor and complex clinical trial design might also account for the small effects seen for antidepressants. The randomized controlled trials used to approve drugs are short, and may not capture
2496-526: Is a person's first seizure and it was "provoked", or caused by another condition, treatment of the cause is usually enough to treat the seizure. If the seizure is "unprovoked", brain imaging is abnormal, and/or EEG is abnormal, start anti-seizure medications is generally recommmended. A seizure can last from a few seconds to 5 minutes. Once it reaches and passes 5 minutes, it is known as status epilepticus . Accidental urination ( urinary incontinence ), stool leaking ( fecal incontinence ), tongue biting, foaming of
2592-495: Is affected. Focal seizures usually consist of motor symptoms or sensory symptoms. Generalized seizures affect both sides of the brain and typically involve both sides of the body. They all involve a loss of consciousness and usually happen without warning. There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures. Seizures have a number of causes. Seizures can be classified into provoked or unprovoked. Provoked seizures have
2688-414: Is also important in evaluating risk for epilepsy. History regarding medication use, substance use, and alcohol use is important in determining a cause of the seizure. Most people are in a postictal state (drowsy or confused) following a seizure. A bite mark on the side of the tongue or bleeding from the mouth strongly indicates a seizure happened. But only a third of people who have had a seizure have such
2784-460: Is an increased risk of suicidal thinking and behavior when taken by children, adolescents, and young adults. Discontinuation syndrome , which resembles recurrent depression in the case of the SSRI class, may occur after stopping the intake of any antidepressant, having effects which may be permanent and irreversible. Research regarding the effectiveness of antidepressants for depression in adults
2880-509: Is arbitrary, and that antidepressants consistently result in significantly raised scores on the mood item of the scale. Assessments of antidepressants using alternative, more sensitive scales, such as the MADRS , do not result in marked difference from the HDRS and likewise only find a marginal clinical benefit. Another hypothesis proposed to explain the poor performance of antidepressants in clinical trials
2976-483: Is controversial and has found both benefits and drawbacks. Meanwhile, evidence of benefit in children and adolescents is unclear, even though antidepressant use has considerably increased in children and adolescents in the 2000s. While a 2018 study found that the 21 most commonly prescribed antidepressant medications were slightly more effective than placebos for the short-term (acute) treatments of adults with major depressive disorder , other research has found that
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3072-574: Is currently unclear which factors predict partial remission. However, it is clear that residual symptoms are powerful predictors of relapse, with relapse rates three to six times higher in people with residual symptoms than in those, who experience full remission. In addition, antidepressant drugs tend to lose efficacy throughout long-term maintenance therapy . According to data from the Centers for Disease Control and Prevention , less than one-third of Americans taking one antidepressant medication have seen
3168-524: Is done to detect structural problems inside the brain, such as tumors. MRI is generally the better imaging test, but CT scan is preferred when intracranial bleeding is suspected. Imaging may be done at a later point in time in those who return to their normal selves while in the emergency room. An electroencephalography (EEG) measures the brain's electrical activity. It is used in cases of first seizures that have no provoking factor, normal head imaging, and no prior history of head trauma. It will help determine
3264-639: Is estimated to result in costs of US$ 1.7 billion or 0.5% of the GDP. They make up about 1% of emergency department visits (2% for emergency departments for children) in the United States. Scientific work into the prediction of epileptic seizures began in the 1970s. Several techniques and methods have been proposed, but evidence regarding their usefulness is still lacking. Two promising areas include: (1) gene therapy , and (2) seizure detection and seizure prediction . Gene therapy for epilepsy consists of employing vectors to deliver pieces of genetic material to areas of
3360-506: Is found, it is called an idiopathic seizure. After a first unprovoked seizure, the chance of experiencing a second one is about 40% within 2 years. People with repeated unprovoked seizures are diagnosed with epilepsy . Doctors assess a seizure by first ruling out other conditions that look similar to seizures, such as fainting and strokes. This includes taking a detailed history and ordering blood tests. They may also order an electroencephalogram (EEG) and brain imaging (CT and/or MRI). If it
3456-410: Is higher in those who experienced brain bleeds, with 10-16% risk in those patients. Recent traumatic brain injury may also lead to seizures. 1 to 5 of every 10 people who have had traumatic brain injury have experienced at least one seizure. Seizures may occur within 7 days of the injury (early posttraumatic seizure ) or after 7 days have passed (late posttraumatic seizure). Space-occupying lesions in
3552-423: Is less than 20% regardless of treatment. Those who have a seizure that is provoked have a low risk of re-occurrence, but have a higher risk of death compared to those with epilepsy. Approximately 8–10% of people will experience an epileptic seizure during their lifetime. In adults, the risk of seizure recurrence within the five years following a new-onset seizure is 35%; the risk rises to 75% in persons who have had
3648-491: Is loss of inhibitory neurons because they die due to the injury. The brain may also adapt and make new neuron connections that may be hyper-excitatory. Brief seizures, such as absence seizures lasting 5–10 seconds, do not cause observable brain damage. More prolonged seizures have a higher risk of neuronal death. Prolonged and recurrent seizures, such as status epilepticus, typically cause brain damage. Scarring of brain tissue ( gliosis ), neuronal death, and shrinking of areas of
3744-542: Is not typically recommended if it was a provoked seizure that can be corrected. Examples of causes of provoked seizures that can be corrected include low blood sugar, low blood sodium, febrile seizures in children, and substance/medication use. Starting anti-seizure medications is usually for those with medium to high risk of seizures re-occurring. This includes people with unprovoked seizures with abnormal brain imaging or abnormal EEG. It also includes those who have had more than one unprovoked seizure more than 24 hours apart. It
3840-457: Is often selectively reported in trials of antidepressants. For children and adolescents, fluvoxamine is effective in treating a range of anxiety disorders. Fluoxetine, sertraline, and paroxetine can also help with managing various forms of anxiety in children and adolescents. Meta-analyses of published and unpublished trials have found that antidepressants have a placebo -subtracted effect size ( standardized mean difference or SMD) in
3936-465: Is ordered to rule out abnormal sugar levels (hypoglycemia or hyperglycemia) or electrolyte abnormalities (such as hyponatremia) as a cause. A lumbar puncture is mainly done if there is reason to believe infection or inflammation of the nervous system is occurring. Toxicology screening is also mainly done if history is suggestive. Brain imaging by CT scan and MRI is recommended after a first seizure, especially if no provoking factors are discovered . It
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4032-411: Is planned. Reviews of antidepressants generally find that they benefit adults with depression. On the other hand, some contend that most studies on antidepressant medication are confounded by several biases: the lack of an active placebo , which means that many people in the placebo arm of a double-blind study may deduce that they are not getting any true treatment, thus destroying double-blindness;
4128-498: Is recommended to start with one anti-seizure medication. Another may be added if one is not enough to control the seizure occurrence. Approximately 70% of people can obtain full control with continuous use of medication. The type of medication used is based on the type of seizure. Anti-seizure medications may be slowly stopped after a period of time if a person has just experienced one seizure and has not had anymore. The decision to stop anti-seizure medications should be discussed between
4224-407: Is recommended. During an active seizure, the person seizing should be slowly laid on the floor. Witnesses should not try to stop the convulsions or other movements. Potentially sharp or dangerous objects should be moved from the area around a person experiencing a seizure so that the individual is not hurt. Nothing should be placed in the person's mouth as it is a choking hazard. After the seizure, if
4320-652: Is significantly higher than what paroxetine and sertraline achieved. However, it did not address as many symptoms of PTSD as paroxetine and sertraline, in part due to the fact that venlafaxine is an SNRI . This class of drugs inhibits the reuptake of norepinephrine, which may cause anxiety in some patients. Fluvoxamine, escitalopram, and citalopram were not well-tested for this disorder. MAOIs , while some of them may be helpful, are not used much because of their unwanted side effects. This leaves paroxetine and sertraline as acceptable treatment options for some people, although more effective antidepressants are needed. Panic disorder
4416-524: Is that the psychoactive effects of antidepressants may lead to the unblinding of participants or researchers, enhancing the placebo effect and biasing results. Some have therefore maintained that antidepressants may only be active placebos. When these and other flaws in the research literature are not taken into account, meta-analyses may find inflated results on the basis of poor evidence. Critics contend that antidepressants have not been proven sufficiently effective by RCTs or in clinical practice and that
4512-622: Is the best treatment, but more research is needed to be certain. Sertraline, escitalopram, and duloxetine may also help reduce symptoms. A 2023 systematic review and meta-analysis of randomized controlled trials of antidepressants for major depressive disorder found that the medications provided only small or doubtful benefits in terms of quality of life . Likewise, a 2022 systematic review and meta-analysis of randomized controlled trials of antidepressants for major depressive disorder in children and adolescents found small improvements in quality of life. Quality of life as an outcome measure
4608-486: Is the result of pharmaceutical advertising, research manipulation, and misinformation. Current mainstream psychiatric opinion recognizes the limitations of antidepressants but recommends their use in adults with more severe depression as a first-line treatment. The American Psychiatric Association 2000 Practice Guideline advises that where no response is achieved within the following six to eight weeks of treatment with an antidepressant, switch to an antidepressant in
4704-551: Is treated relatively well with medications compared to other disorders. Several classes of antidepressants have shown efficacy for this disorder, with SSRIs and SNRIs used first-line. Paroxetine, sertraline, and fluoxetine are FDA-approved for panic disorder, while fluvoxamine, escitalopram, and citalopram are also considered effective for them. SNRI venlafaxine is also approved for this condition. Unlike social anxiety and PTSD , some TCAs antidepressants , like clomipramine and imipramine, have shown efficacy for panic disorder. Moreover,
4800-435: Is used off-label with acceptable efficiency. However, there is not enough evidence to support Citalopram for treating social anxiety disorder, and fluoxetine was no better than a placebo in clinical trials. SSRIs are used as a first-line treatment for social anxiety, but they do not work for everyone. One alternative would be venlafaxine , an SNRI , which has shown benefits for social phobia in five clinical trials against
4896-608: The MAOI phenelzine is also considered useful. Panic disorder has many drugs for its treatment. However, the starting dose must be lower than the one used for major depressive disorder because people have reported an increase in anxiety as a result of starting the medication. In conclusion, while panic disorder's treatment options seem acceptable and useful for this condition, many people are still symptomatic after treatment with residual symptoms. Antidepressants are recommended as an alternative or additional first step to self-help programs in
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#17328691846244992-594: The Sacred Disease , who proposed that the source of epilepsy was from natural causes rather than supernatural ones. Early surgical treatment of epilepsy was primitive in Ancient Greek, Roman and Egyptian medicine. The 19th century saw the rise of targeted surgery for the treatment of epileptic seizures, beginning in 1886 with localized resections performed by Sir Victor Horsley , a neurosurgeon in London. Another advancement
5088-666: The Wikimedia System Administrators, please include the details below. Request from 172.68.168.226 via cp1108 cp1108, Varnish XID 823568218 Upstream caches: cp1108 int Error: 429, Too Many Requests at Fri, 29 Nov 2024 08:33:04 GMT Antidepressants Antidepressants are a class of medications used to treat major depressive disorder , anxiety disorders , chronic pain , and addiction . Common side effects of antidepressants include dry mouth , weight gain , dizziness , headaches , akathisia , sexual dysfunction , and emotional blunting . There
5184-470: The benefit of antidepressants for anxiety disorders is attributable to placebo responses rather than to the effects of the antidepressants themselves. Antidepressants are recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of generalized anxiety disorder (GAD) that has failed to respond to conservative measures such as education and self-help activities. GAD
5280-491: The brain ( abscesses , tumours ) are one cause of unprovoked seizures. In people with brain tumours , the frequency of epilepsy depends on the location of the tumor in the cortical region . Abnormalities in blood vessels of the brain ( Arteriovenous malformation ) can also cause epilepsy. In babies and children, congenital brain abnormalities, such as lissencephaly or polymicrogyria , will also result in epilepsy. Hypoxic-ischemic encephalopathy in newborns will also predispose
5376-410: The brain ( atrophy ) are linked to recurrent seizures. These changes may lead to the development of epilepsy. Diagnosis of seizures involve gathering history, doing a physical exam, and ordering tests. These are done to classify the seizure and determine if the seizure is provoked or unprovoked. Events leading up to the seizure and what movements occurred during the seizure are important in classifying
5472-410: The brain involved in seizure onset. Seizure prediction is a special case of seizure detection in which the developed systems is able to issue a warning before the clinical onset of the epileptic seizure. Computational neuroscience has been able to bring a new point of view on the seizures by considering the dynamical aspects. Neural oscillation Too Many Requests If you report this error to
5568-571: The condition is serious, it is not particularly common, generally only appearing at high doses or while on other medications. Assuming proper medical intervention has been taken (within about 24 hours) it is rarely fatal. Antidepressants appear to increase the risk of diabetes by about 1.3-fold. MAOIs tend to have pronounced (sometimes fatal) interactions with a wide variety of medications and over-the-counter drugs . If taken with foods that contain very high levels of tyramine (e.g., mature cheese, cured meats, or yeast extracts), they may cause
5664-470: The difference is modest and it is not clear that their statistical superiority results in clinical efficacy. The aggregate effect of antidepressants typically results in changes below the threshold of clinical significance on depression rating scales. Proponents of antidepressants counter that the most common scale, the HDRS , is not suitable for assessing drug action, that the threshold for clinical significance
5760-416: The doctor and patient, weighing the benefits and risks. In severe cases where seizures are uncontrolled by at least two anti-seizure medications, brain surgery can be a treatment option. Epilepsy surgery is especially useful for those with focal seizures where the seizures are coming from a specific part of the brain. The amount of brain removed during the surgery depends on the extent of the brain involved in
5856-549: The effects of serotonergic psychedelics like psilocybin and lysergic acid diethylamide (LSD). Among individuals treated with a given antidepressant, between 30% and 50% do not show a response. Approximately one-third of people achieve a full remission , one-third experience a response, and one-third are non-responders. Partial remission is characterized by the presence of poorly defined residual symptoms. These symptoms typically include depressed mood, anxiety, sleep disturbance, fatigue, and diminished interest or pleasure. It
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#17328691846245952-424: The efficacy of combining modafinil for treatment-resistant people. It has been used to help combat SSRI-associated fatigue. The effects of antidepressants typically do not continue once the course of medication ends. This results in a high rate of relapse . In 2003, a meta-analysis found that 18% of people who had responded to an antidepressant relapsed while still taking it, compared to 41% whose antidepressant
6048-829: The evidence supporting this association is of low quality. Bupropion is used to help people stop smoking . Antidepressants are also used to control some symptoms of narcolepsy . Antidepressants may be used to relieve pain in people with active rheumatoid arthritis . However, further research is required. Antidepressants have been shown to be superior to placebo in treating depression in individuals with physical illness, although reporting bias may have exaggerated this finding. Antidepressants have been shown to improve some parts of cognitive functioning for depressed users, such as memory, attention, and processing speed. Certain antidepressants acting as serotonin 5-HT 2A receptor antagonists, such as trazodone and mirtazapine , have been used as hallucinogen antidotes or "trip killers" to block
6144-445: The first two years. The greatest predictors of more seizures are problems either on the EEG or on imaging of the brain. Those with normal EEG and normal physical exam following a first unprovoked seizure had less of risk of recurrence in the next two years, with a risk of 25%. In adults, after 6 months of being seizure-free after a first seizure, the risk of a subsequent seizure in the next year
6240-537: The full effect of antidepressants. Additionally, the placebo effect might be inflated in these trials by frequent clinical consultation, lowering the comparative performance of antidepressants. Critics agree that current clinical trials are poorly-designed, which limits the knowledge on antidepressants. More naturalistic studies, such as STAR*D , have produced results, which suggest that antidepressants may be less effective in clinical practice than in randomized controlled trials. Critics of antidepressants maintain that
6336-434: The idea that low serotonin levels cause depression is not supported by scientific evidence. Proponents of the monoamine hypothesis of depression recommend choosing an antidepressant which impacts the most prominent symptoms. Under this practice, for example, a person with MDD who is also anxious or irritable would be treated with selective serotonin reuptake inhibitors (SSRIs) or norepinephrine reuptake inhibitors , while
6432-425: The lack of inhibition of neurons resulting in seizures. Glutamate serves to excite neurons into firing when appropriate. It was found to be increased in those with epilepsy. This is a possible mechanism for why there is hyper-excitability of neurons in seizures. Seizures that occur after brain injury may be due to the brain adapting to injury ( neuroplasticity ). This process is known as epileptogenesis . There
6528-501: The medication, and less than half achieve remission . Placebo responses are a large component of the benefit of antidepressants in the treatment of depression and anxiety. However, placebo responses with antidepressants are lower in magnitude in the treatment of OCD compared to depression and anxiety. A 2019 meta-analysis found placebo improvement effect sizes (SMD) of about 1.2 for depression, 1.0 for anxiety disorders, and 0.6 for OCD with antidepressants. Antidepressants are one of
6624-481: The most effective class, with moderate effects on pain and sleep, and small effects on fatigue and health-related quality of life. The fraction of people experiencing a 30% pain reduction on tricyclics was 48%, versus 28% on placebo. For SSRIs and SNRIs, the fractions of people experiencing a 30% pain reduction were 36% (20% in the placebo comparator arms) and 42% (32% in the corresponding placebo comparator arms) respectively. Discontinuation of treatment due to side effects
6720-424: The mouth, and turning blue due to inability to breathe commonly are seen in seizures. A period of confusion typically follows the seizure that lasts from seconds to hours before a person returns to normal. This period is called a postictal period . Other symptoms during this period include drowsiness, headache, difficulty speaking, psychosis, and weakness. Observable signs and symptoms of seizures vary depending on
6816-622: The newborn to epilepsy. Strokes, brain bleeds, and traumatic brain injury can all also lead to epilepsy if seizures re-occur. If the first seizure occurs more than 7 days following a stroke, there is a higher chance of the person developing epilepsy. Post-stroke epilepsy accounts for 30%-50% of new epilepsy cases. This is also the case for traumatic brain injury, with 80% of people with late posttraumatic seizures having another seizure occur, classifying it as epilepsy. Infections of newborns that occur while before or during birth, such as herpes simplex virus , rubella , and cytomegalovirus , all carry
6912-405: The newer anticonvulsants . A combination strategy involves adding another antidepressant, usually from a different class to affect other mechanisms. Although this may be used in clinical practice, there is little evidence for the relative efficacy or adverse effects of this strategy. Other tests conducted include the use of psychostimulants as an augmentation therapy. Several studies have shown
7008-433: The person is not fully conscious and alert, they should be turned to their side to prevent choking. This is called recovery position . Timing of the seizure is also important. If a seizure is longer than five minutes, or there are two or more seizures occurring in five minutes, it is a medical emergency known as status epilepticus . Emergency services should be called. The first line medication for an actively seizing person
7104-529: The person returns to normal. If a seizure lasts longer than 5 minutes, it is a medical emergency ( status epilepticus ) and needs immediate treatment. Seizures can be classified as provoked or unprovoked. Provoked seizures have a cause that can be fixed, such as low blood sugar , alcohol withdrawal , high fever , recent stroke , and recent head trauma . Unprovoked seizures have no clear cause or fixable cause. Examples include past strokes, brain tumors, brain vessel malformations, and genetic disorders. If no cause
7200-664: The placebo effect may account for most or all of the drugs' observed efficacy. Research on the effectiveness of antidepressants is generally done on people who have severe symptoms, a population that exhibits much weaker placebo responses, meaning that the results may not be extrapolated to the general population that has not (or has not yet) been diagnosed with anxiety or depression. Antidepressants are prescribed to treat major depressive disorder (MDD), anxiety disorders , chronic pain , and some addictions. Antidepressants are often used in combination with one another. Despite its longstanding prominence in pharmaceutical advertising,
7296-433: The risk for relapse . Antidepressants can cause various adverse effects , depending on the individual and the drug in question. Almost any medication involved with serotonin regulation has the potential to cause serotonin toxicity (also known as serotonin syndrome ) – an excess of serotonin that can induce mania, restlessness, agitation, emotional lability , insomnia, and confusion as its primary symptoms. Although
7392-709: The risk of relapse and that SSRIs are typically better tolerated than other antidepressants. American Psychiatric Association (APA) treatment guidelines recommend that initial treatment be individually tailored based on factors including the severity of symptoms, co-existing disorders, prior treatment experience, and the person's preference. Options may include antidepressants, psychotherapy , electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or light therapy . The APA recommends antidepressant medication as an initial treatment choice in people with mild, moderate, or severe major depression, and that should be given to all people with severe depression unless ECT
7488-459: The same class, and then to a different class. A 2006 meta-analysis review found wide variation in the findings of prior studies: for people who had failed to respond to an SSRI antidepressant, between 12% and 86% showed a response to a new drug. However, the more antidepressants an individual had previously tried, the less likely they were to benefit from a new antidepressant trial. However, a later meta-analysis found no difference between switching to
7584-412: The seizures. It can range from just removing one lobe of the brain ( temporal lobectomy ) to disconnecting an entire side of the brain ( hemispherectomy ). The procedure can be curative, where seizures are eliminated completely. However, if it is not curative, it can be palliative that reduces the frequency of seizures but does not eliminate it. Helmets may be used to provide protection to the head during
7680-446: The so-called drug-induced QT prolongation , especially in older adults; this condition can degenerate into a specific type of abnormal heart rhythm called Torsades de points , which can potentially lead to sudden cardiac arrest . Some antidepressants are also believed to increase thoughts of suicidal ideation . Antidepressants have been associated with an increased risk of dementia in older adults. Researchers have developed
7776-591: The superiority of antidepressants over placebo is the result of systemic flaws in clinical trials and the research literature. Trials conducted with industry involvement tend to produce more favorable results, and accordingly many of the trials included in meta-analyses are at high risk of bias. Additionally, meta-analyses co-authored by industry employees find more favorable results for antidepressants. The results of antidepressant trials are significantly more likely to be published if they are favorable, and unfavorable results are very often left unpublished or misreported,
7872-610: The treatment of bulimia nervosa . SSRIs (fluoxetine in particular) are preferred over other antidepressants due to their acceptability, tolerability, and superior reduction of symptoms in short-term trials. Long-term efficacy remains poorly characterized. Bupropion is not recommended for the treatment of eating disorders, due to an increased risk of seizure. Similar recommendations apply to binge eating disorder . SSRIs provide short-term reductions in binge eating behavior, but have not been associated with significant weight loss. Clinical trials have generated mostly negative results for
7968-605: The treatment of neuropathic pain and found limited useful randomized clinical trial data. They concluded that the long history of successful use in the community for the treatment of fibromyalgia and neuropathic pain justified its continued use. The group was concerned about the potential overestimation of the amount of pain relief provided by amitriptyline, and highlighted that only a small number of people will experience significant pain relief by taking this medication. Antidepressants may be modestly helpful for treating people who have both depression and alcohol dependence , however,
8064-407: The treatment of anxiety disorders of around 0.3, which equates to a small improvement and is roughly the same magnitude of benefit as their effectiveness in the treatment of depression. The effect size (SMD) for improvement with placebo in trials of antidepressants for anxiety disorders is approximately 1.0, which is a large improvement in terms of effect size definitions. In relation to this, most of
8160-485: The treatment options for PTSD . However, their efficacy is not well established. Paroxetine and sertraline have been FDA approved for the treatment of PTSD. Paroxetine has slightly higher response and remission rates than sertraline for this condition. However, neither drug is considered very helpful for a broad patient demographic. Fluoxetine and venlafaxine are used off-label. Fluoxetine has produced unsatisfactory mixed results. Venlafaxine showed response rates of 78%, which
8256-547: The two maintains our central nervous system. In those with seizures, neurons are both hyperexcitable and hypersynchronous, where many neurons fire numerously at the same time. This may be due to an imbalance of excitation and inhibition of neurons. γ-aminobutyric acid (GABA) and Glutamate are chemicals called neurotransmitters that work by opening or closing ion channels on neurons to cause inhibition or excitability. GABA serves to inhibit neurons from firing. It has been found to be decreased in epilepsy patients. This may explain
8352-434: The type of seizure or epilepsy syndrome present, as well as where the seizures are coming from if its focal. It is also used when a person has not returned to baseline after a seizure for a prolonged time. Other conditions that commonly get mistaken for a seizure include syncope , psychogenic nonepileptic seizures , cardiac arrhythmias , migraine headaches , and stroke / transient ischemic attacks . There are times when
8448-701: The type of seizure. The person's memory of what happened before and during the seizure is also important. However, since most people that experience seizures do not remember what happened, it is best to get history from a witness when possible. Video recording of the seizure is also helpful in diagnosis of seizures. Events that occurred after the seizure are also an important part of the history. Past medical history, such as past head trauma, past strokes, past febrile seizures, or past infections, are helpful. In babies and children, information about developmental milestones, birth history, and previous illnesses are important as potential epilepsy risk factors. Family history of seizures
8544-407: The type. Seizures can be classified into generalized seizures and focal seizures, depending on what part of the brain is involved. Focal seizures affect a specific area of the brain, not both sides. It may turn into a generalized seizure if the seizure spreads through the brain. Consciousness may or may not be impaired. The signs and symptoms of these seizures depends on the location of the brain that
8640-613: The use of SSRIs in the treatment of anorexia nervosa . Treatment guidelines from the National Institute of Health and Care Excellence (NICE) recommend against the use of SSRIs in this disorder. Those from the American Psychiatric Association (APA) note that SSRIs confer no advantage regarding weight gain, but may be used for the treatment of co-existing depressive, anxiety, or obsessive–compulsive disorders. A 2012 meta-analysis concluded that antidepressant treatment favorably affects pain, health-related quality of life, depression, and sleep in fibromyalgia syndrome. Tricyclics appear to be
8736-450: The widespread use of antidepressants is not evidence-based. They also note that adverse effects, including withdrawal difficulties, are likely underreported, skewing clinicians' ability to make risk-benefit judgements. Accordingly, they believe antidepressants are overused, particularly for non-severe depression and conditions in which they are not indicated. Critics charge that the widespread use and public acceptance of antidepressants
8832-485: The work of " evil spirits ". The perception of epilepsy, however, began to change in the time of Ancient Greek medicine. The term "epilepsy" itself is a Greek word, which is derived from the verb "epilambanein", meaning "to seize, possess, or afflict". Although the Ancient Greeks referred to epilepsy as the " sacred disease ", this perception of epilepsy as a "spiritual" disease was challenged by Hippocrates in his work On
8928-621: Was common. Antidepressants including amitriptyline , fluoxetine, duloxetine, milnacipran , moclobemide , and pirlindole are recommended by the European League Against Rheumatism (EULAR) for the treatment of fibromyalgia based on "limited evidence". A 2014 meta-analysis from the Cochrane Collaboration found the antidepressant duloxetine to be effective for the treatment of pain resulting from diabetic neuropathy . The same group reviewed data for amitriptyline in
9024-510: Was shown to be a good treatment option, but its use is limited by dietary restrictions. Moclobemide is a RIMA and showed mixed results, but still received approval in some European countries for social anxiety disorder. TCA antidepressants , such as clomipramine and imipramine , are not considered effective for this anxiety disorder in particular. This leaves out SSRIs such as paroxetine, sertraline, and fluvoxamine CR as acceptable and tolerated treatment options for this disorder. SSRIs are
9120-536: Was switched for a placebo . A gradual loss of therapeutic benefit occurs in a minority of people during the course of treatment. A strategy involving the use of pharmacotherapy in the treatment of the acute episode, followed by psychotherapy in its residual phase, has been suggested by some studies. For patients who wish to stop their antidepressants, engaging in brief psychological interventions such as Preventive Cognitive Therapy or mindfulness-based cognitive therapy while tapering down has been found to diminish
9216-536: Was that of the development by the Montreal procedure by Canadian neurosurgeon Wilder Penfield , which involved use of electrical stimulation among conscious patients to more accurately identify and resect the epileptic areas in the brain. Seizures result in direct economic costs of about one billion dollars in the United States. Epilepsy results in economic costs in Europe of around €15.5 billion in 2004. In India, epilepsy
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