Which Depressed Patients Should Receive Antidepressants?

Summary

Antidepressants lead to improvement in about 70% of unselected patients with a depressive syndrome. However, many of these patients would also improve with the passage of time alone or with support and counselling. Although antidepressants are generally well tolerated, they can be expensive and are not devoid of adverse effects. Accordingly, it is worthwhile considering which patients are most likely to benefit from these drugs.

Patients who are likely to require antidepressants include those with a depression of relatively long duration, a depression of moderate or greater severity, and a depression that has melancholic or psychotic features. Patients with a history of previous depressive or manic episodes, and those showing suicidal ideation are also candidates for antidepressant treatment. Patients who show the sleep electroencephalographic (EEG) changes characteristic of depression and those with enhanced pituitary-adrenocortical activity usually require antidepressant treatment.

Once a depressed patient has responded to antidepressant treatment, further treatment for about 6 months is recommended to minimise the risk of relapse. Patients who are particularly vulnerable to recurrences may benefit from continuing antidepressant treatment beyond 6 months.