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Optimising antidepressant use in clinical practice: towards criteria for antidepressant selection
1Department of Psychiatry, University of Brussels (Erasme Hospital), Route de Lennick 808, 1070 Brussels, Belgium. jmendlew@ulb.ac.be
Background:
Current treatment for depression in primary care and other out-patient settings demonstrates a pattern that is incongruous with the magnitude of the burden of depression suggested by its associated disability.
Aims:
To review important considerations in current depression treatment with a focus on antidepressant use.
Method:
Factors influencing the undertreatment of depression in real-world settings are examined.
Results:
Patient and clinician behaviour as well as the incentives created by the health care system affect the likelihood of realising effective antidepressant therapy in practice.
Conclusions:
Given the complexities of clinical practice, selection criteria for an antidepressant should include safety, efficacy and tolerability, as well as the ability of the antidepressant to deliver real-world efficacy while balancing health care costs in the long term.