New concepts in the management of depression--possibilities with a non-sedative antidepressant

Classification of depression is important, as it may provide a valuable indication of which types of treatment are likely to be effective. Most traditional classification systems follow a dichotomous approach (e.g. endogenous versus exogenous, agitated versus retarded), and consideration of such systems has led to increased understanding of depression. Treatment should be tailored to individual requirements, taking into account the type of depression and the stage at which it is being treated, the patient's personality and idiosyncrasies, and the pharmacological profile of the drug. Group trials show many antidepressants to be of approximately equivalent efficacy; however, side-effect profiles differ. The advent of the second generation antidepressants provides clinicians with non-sedating drugs, often with fewer anticholinergic side-effects. Thus, improved patient compliance and better overall functioning can be expected, as sedation often hinders recovery by producing flattening and monotony of affect, and blunting of emotional involvement and responsiveness, while cholinergic blockade increases confusional states.