Practical psychopharmacologic considerations in depression

Of the antidepressants on the US market, only alprazolam and trazodone have questionable antidepressant efficacy. Because all other antidepressants are equally effective in major depressive illness, drugs are used based on particular patient characteristics matched with individual antidepressant drug profiles. In general, antidepressant plasma concentration monitoring is only clinically useful with some of the TCAs. Nortriptyline, imipramine, and desipramine have demonstrated the highest correlation between clinical response and plasma concentration. MAO inhibitors are useful but require a reliable patient who can comply with dietary restrictions. Maprotiline and amoxapine are not first- or second-line antidepressants. Clomipramine and fluoxetine offer unique properties that make them first- or second-line antidepressants for particular patients. There are significant drug interactions with antidepressants that should be avoided.