[Practical considerations in initial treatment]

The initial treatment for a depressive episode corresponds to the early period of treatment for depression--the period which precedes what is called the phase of consolidatory treatment, which itself is eventually followed by maintenance treatment. Its precise adjustment has been the object of many pharmacological studies, but nevertheless remains largely empirical. The choice of an antidepressant depends on the therapeutic response obtained during previous episodes. The choice of dosage, on the other hand, is well standardised. The essential element is to oversee the treatment, both to detect and correct undesirable effects as well as to improve the target symptoms. Certain therapeutic considerations must be put into practice according to the types of depressive swings, such as secondary depression, chronic depression, manic depression, and atypical depressions. In any event the initial treatment of all depressions remains largely empirical at the present time, and depends on knowledge of the management of antidepressant substances, particularly since the appearance of new families of MAOIs and 5HT agonists.