Rational use of psychotropic drugs. IV. Antidepressants

Rational use of tricyclic antidepressant drugs is discussed. Before using antidepressant drug therapy, the clinician should determine the disease subtype of the depressive syndrome. Response to antidepressants is most favorable in cases of "endogenous" depression and less favorable in cases of situational (reactive) depression. The following considerations regarding tricyclic antidepressant therapy are discussed: dosage schedules, onset of action, anticholinergic effects, cardiac toxicity and drug interactions. Patients who fail to respond to antidepressant drug therapy should be considered candidates for electroconvulsive therapy.