The acute and long-term treatment of major depression

Millions of depressed patients do not receive appropriate treatment in spite of the substantial increase in our knowledge about this major medical problem. In addition to individual suffering, there are tens of thousands of deaths by suicide, an increase in morbidity and mortality from medical illnesses whose course is aggravated by an associated depression, a disruptive effect on family life and childrearing, and an economic loss of billions of dollars. Among the many reasons for the inadequate treatment of depression is the fact that the side effects (anticholinergic, antihistaminic, etc.) of traditional antidepressants result in many patients receiving inadequate doses of medication or discontinuing treatment prematurely. The availability of a new class of antidepressant medications--the selective serotonin reuptake inhibitors (SSRIs)--heralds a new phase in the treatment of depression. Although these drugs are not free of side effects, an increased number of depressed patients now seem able to receive adequate doses of medication and to stay on treatment much longer than in the past. The increased acceptance of SSRIs by patients represents an important phase in our ability to effectively treat larger numbers of patients and to prevent relapse in many of them.