Antidepressant efficacy and side-effect burden: a quick guide for clinicians

Abstract

Prescribing of antidepressant treatment (ADT) for major depressive disorder (MDD) has increased in quantity and popularity over the last two decades. This is likely due to the approval of safer medications, better education of clinicians and their patients, direct-to-consumer marketing practices, and less stigma associated with those taking ADT. This trend has also been met with some controversy, however, as the ongoing safety and effectiveness of these treatments have at times been called into question. This paper discusses the differing levels of evidence that support the use of ADT based on (A) Food and Drug Administration approvals, (B) data from randomized controlled trials or meta-analyses and, where these are not available, the authors discuss and apply, (C) theoretical pharmacodynamic principles to justify antidepressant choice in the treatment of MDD patients. The final section discusses standard psychopharmacology guideline approaches to better alert the reader as to which practices are commonplace compared with those which are more outside of the standard of care.

Perspectives of a pharmacist‐run pharmacogenomic service for depression in interdisciplinary family medicine practices

“…Adequate treatment for depression is an ongoing challenge for health care providers, with only 66% of patients having improvement in their symptoms after the first trial of a medication . Current practice guidelines for prescribing antidepressants recommend a generic, “one size fits all” approach and disregards significant variability in individuals and patient populations . Appropriate drug selection and initial dosing is often not individualized for patients, which can lead to a multitude of drug therapy problems .…”

“…10 Current practice guidelines for prescribing antidepressants recommend a generic, "one size fits all" approach and disregards significant variability in individuals and patient populations. 11 Appropriate drug selection and initial dosing is often not individualized for patients, which can lead to a multitude of drug therapy problems. 12 It is approximated that 20% of patients remain inadequately treated 2 years after a diagnosis of depression is made, and 15% of patients are classified as treatmentresistant.…”

Metabolic risk in depression and treatment with selective serotonin reuptake inhibitors: are the metabolic syndrome and an increase in cardiovascular risk unavoidable?

“…SSRIs have become very popular in clinical use owing to various beneficial characteristics, including their ease of administration, increased pharmacodynamic specificity, and enhanced tolerability with relatively minor side effects; in contrast to the "dirtier", less specific and tolerable older antidepressant drugs, such as tricyclics and monoamine oxidase inhibitors [16] . Although this distinction is notorious regarding cardiovascular safety, the underlying molecular differences in their pharmacologic profiles remain largely elusive [17] .…”

Estimation of an Appropriate Dose of Trazodone for Pediatric Insomnia and the Potential for a Trazodone–Atomoxetine Interaction

“…Trazodone exerts its antidepressant activity acting as serotonin antagonist and reuptake inhibitor. It is indicated primarily for the treatment of depression in patients who do not respond to antidepressants, such as selective serotonin reuptake inhibitors . As a result of the combined serotoninergic receptor antagonism and serotonin reuptake inhibition, trazodone has demonstrated unique therapeutic flexibility, which has given rise to its potential use in a broad range of comorbidities of major depressive disorder as well as off‐label indications, including insomnia .…”

“…It is indicated primarily for the treatment of depression in patients who do not respond to antidepressants, such as selective serotonin reuptake inhibitors. 7 As a result of the combined serotoninergic receptor antagonism and serotonin reuptake inhibition, trazodone has demonstrated unique therapeutic flexibility, which has given rise to its potential use in a broad range of comorbidities of major depressive disorder as well as off-label indications, including insomnia. 8,9 Trazodone also shows a sedating activity, with reviews indicating that insomnia is the most common reason for its off-label prescription and use in adult and pediatric populations.…”