The use of antidepressants in clinical practice

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Abstract
The depressive syndrome encompasses several important subtypes of depression that differ in terms of optimal treatment selection, prognosis, and influence of psychosocial factors. These subtypes are distinguished from one another by psychiatric history and patterns of symptoms. Depressions are common. There are a number of different efficacious treatments. In many patients, the use of antidepressants, along with supportive therapy, produces a rapid rate of improvement, ameliorates symptoms, decreases the risk of suicide and facilitates resumption of normal everyday activities. Most clinicians prefer to use drug treatment [tricyclic antidepressants, monoamine oxidase inhibitors, lithium carbonate, phenothiazines] and psychotherapies and try to avoid hospitalization. [Electroconvulsive therapy is discussed.] In current practice, most patients with depressions can be treated effectively on an outpatient basis. The possibility of suicide requires particularly careful consideration. Hospitalization is of particular value for patients who are severely depressed, psychotic and unable to function, or for those with concomitant medical conditions requiring special care. Given the availability of several effective treatments, i.e., drugs, psychotherapies and others, the skillful physician is urged to adopt a pluralistic view.

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