Expanding psychopharmacologic treatment options for the depressed medical patient

Psychopharmacologic treatment of depression in medically ill patients is greatly enhanced by the availability of new antidepressant medications that have low or no anticholinergic, anti-alpha-adrenergic, antihistaminic, and quinidine-like properties. This article discusses the important pharmacodynamic and pharmacokinetic properties of the selective serotonin reuptake inhibitors (fluoxetine, paroxetine, and sertraline), bupropion, venlafaxine, and nefazodone--with an emphasis on their side effects relevant to medical patients as well as important drug interactions. In addition, the safety of these newer medications is compared with that of tricyclics; the role for continued tricyclic use in the medical-psychiatric population is examined; the use of electroconvulsive therapy in medically ill patients who are refractory to antidepressants is also briefly discussed.