Update on some of the older and newer antidepressants

This is an edited transcription of a presentation made to a group of primary care physicians, medical students, and consultation-liaison psychiatrists. Primary care physicians frequently prescribe antidepressant medications to their patients. These medications are frequently misprescribed, often in dosages that are too low to have an optimal effect. In part this is due to generally exaggerated fears that primary care physicians have regarding these medications, especially the anticholinegic effects of recommended dosage levels and sudden cardiac death. This is rarely a problem except in overdosage or those with dangerous preexisting cardiac arrhythmias. The author reviews his thoughts about some of the more recently introduced agents, including the usual, positive, psychologic responses (placebo effects) to any new drug. The newer agents are not more efficacious than older agents but have different side-effect profiles. The common side effects, and have these may be minimized or in some cases used to the patient's advantages, are discussed for the older and newer agents.