Depression: medical interface with psychiatry and treatment advances

A number of advances, primarily pharmacologic, have occurred in recent years in the treatment of depression. Some of the recent advances relating to neurotransmitters and other neuropsychiatric factors believed to be related to depression are discussed, including how antidepressants may affect these systems. Some more recently recognized or often overlooked side effects of antidepressants are also discussed, as well as differential side effect profiles. The second generation antidepressants are critiqued and are generally believed to be no better than many of the first generation antidepressants. The usefulness of and indications for tricyclic serum levels and standard neuroendocrine tests for depression are summarized. Recent findings regarding lithium, including augmentation, and monoamine oxidase inhibitors, especially for atypical depressions with panic symptoms, are included, as is the use of psychostimulants, especially for medically ill patients who cannot take other antidepressants.