Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Desvenlafaxine is an oral drug that is used
for treating depression. It is in a class of drugs called selective serotonin
and norepinephrine reuptake inhibitors (SNRI); a class that also contains
venlafaxine (Effexor) and duloxetine (Cymbalta). (Desvenlafaxine is an active
metabolite of venlafaxine, that is, it is a product of venlafaxine that is
manufactured by the body from venlafaxine.) Desvenlafaxine affects
neurotransmitters, the chemicals that nerves within the brain make and release
in order to communicate with each other. Neurotransmitters either travel across
the space between nerves and attach to receptors on the surface of nearby nerves
or they attach to receptors on the surface of the nerves that produced them, to
be taken up by the nerve and released again (a process referred to as
re-uptake).
Many experts believe that an imbalance among neurotransmitters is the cause
of depression. Serotonin and norepinephrine are two neurotransmitters released
by nerves in the brain. Desvenlafaxine works by preventing the reuptake of
serotonin and epinephrine by nerves after they have been released. Since uptake
is an important mechanism for removing released neurotransmitters and
terminating their actions on adjacent nerves, the reduced uptake caused by
desvenlafaxine increases the effect of serotonin and norepinephrine in the
brain. The FDA approved desvenlafaxine in February 2008.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets (extended release): 50, and 100 mg
STORAGE: Tablets should be kept at room temperature, 68-77 F
(20-25 C).
PRESCRIBED FOR: Desvenlafaxine is used for the treatment of major
depression.
DOSING: The recommended dose of desvenlafaxine is 50 mg daily, with or
without food. Doses greater than 50 mg are not more effective but cause more
side effects.
DRUG INTERACTIONS: All SNRIs, including desvenlafaxine, should not be
taken with any of the monoamine oxidase inhibitor (MAOI) class of
antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), selegiline (Eldepryl), and
procarbazine (Matulane) or
other drugs that inhibit monoamine oxidase [for example,
linezolid (Zyvox)]. Such combinations may
lead to confusion, high blood pressure, tremor, hyperactivity,
coma, and death.
Desvenlafaxine should not be administered within 14 days after stopping MAOIs
and MAOIs should not be administered within 7 days of stopping desvenlafaxine.
Similar reactions may occur if desvenlafaxine is combined with other SNRIs,
selective serotonin reuptake inhibitors [for example, fluoxetine (Prozac) or paroxetine
(Paxil)] or other drugs that increase serotonin in the brain, for example, tryptophan,
St. John's wort,
meperidine (Demerol) or tramadol (Ultram).
SNRIs may increase the effect of warfarin
(Coumadin), leading to excessive bleeding.
Warfarin therapy should be monitored more frequently in patients who are also
taking desvenlafaxine. Combining SNRIs with
aspirin,
nonsteroidal
antiinflammatory drugs (NSAIDs) or other drugs that affect bleeding may increase the
likelihood of upper gastrointestinal bleeding.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Dysthymia is a less severe form of chronic depression. Symptoms and signs include insomnia, suicidal thoughts, guilt, empty feeling, loss of energy, helplessness, sluggishness, and persistent aches and pains. Treatment may involve psychotherapy, electroconvulsive therapy, and antidepressants.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Depression in teenagers may be caused by many factors. Symptoms of teen depression include apathy, irresponsible behavior, sadness, sudden drop in grades, withdrawal from friends, and alcohol and drug use. Treatment of depression in adolescents may involve psychotherapy and medications.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
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