[Therapeutic strategies for depression]

To date, no one antidepressant medication has been proven to be more efficient than another. Physicians are still waiting for good criteria to select which antidepressant has more chances of being effective in certain patients. Nevertheless, guidelines for antidepressant prescription could improve the rate of success in treating depression. All antidepressant medications share the same indication: a major depressive episode. Some compounds have indications other than a major depressive episode, which may be taken into account by the prescribing physician. Many researchers have tried to identify predictive criteria of response to antidepressants. The predictive clinical criteria include: endogeneity, early response, severity and duration of depression, pathological personality traits, quality of the environment, and co-morbid organic abnormalities. Paraclinical criteria have also been studied: levels of monoamines, neuro-endocrinological parameters, enzymatic activities, polysomnography, and brain imaging. Different recommendations have been proposed to guide therapeutic strategies from the acute period to the post-acute period, but three items have been mentioned most often: risk of negative side effects, patient expectations, and level of proof of efficacy of the compounds. Mild to moderate major depressive episodes raise a difficult question: can psychotherapy be an alternative option to antidepressant medication?