Pharmacological management of depressive disorders

Abstract

This article outlines current guidelines for the pharmacological treatment of depression. For acute treatment of moderate to severe depression in the absence of specific factors, the recommendation is treatment with a selective serotonin reuptake inhibitor or mirtazapine. Other options for acute antidepressant treatment are discussed, and advantages and disadvantages of specific drugs are outlined. Recommendations for next-step treatment for patients with an inadequate response include increasing the dose, switching to another antidepressant, augmentation with another agent or using a combination of antidepressants. Again, recommendations for specific drugs are outlined, and the common advantages and disadvantages of specific drugs are listed in a table format. The options for non-pharmacological treatments are briefly explored in regards to symptom severity and other clinical features, and a list of non-pharmacological treatment options is provided.

Treating depression with adjunctive antipsychotics

“…These include assessing the adequacy of dose and treatment adherence; reviewing the diagnosis, including possible psychiatric and medical co‐morbidity; and considering chronic social difficulties. The next steps are to increase the dose, switch to another antidepressant (possibly from a different class), combine antidepressants or add an adjunctive therapy 7…”