Status of treatment of depression

Depression is a common and highly treatable disorder, with most patients returning to predepression levels of functioning. Patients with depression must be carefully assessed for the presence of comorbid psychiatric or medical disorders, as well as psychosocial stresses.

I present a clinical overview, supported by pertinent literature, of currently available treatments of depression, with an emphasis on primary practice.

Beyond diagnosis, treatment consists of patient education and support, evaluation of suicide risk, and treatment of symptoms with antidepressant medication, psychotherapy, or both. A multitude of antidepressants are available, including cyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and newer, more receptor-specific agents such as nefazodone, venlafaxine, and mirtazapine. These are reviewed with a focus on mechanism of action, side-effect profile, and clinical use.

All available antidepressants have been found effective in the treatment of mild-to-moderate depression. Choice of agent is based primarily on side-effect profile. For patients with an atypical pattern of symptoms, SSRIs or MAOIs may be the most useful. Patients with severe depression or melancholic symptoms may respond better to tricyclic antidepressants, venlafaxine, or mirtazapine.