The case for an individual
approach to the treatment of depression

by
Healy D
North Wales Department of Psychological Medicine,
University of Wales College of Medicine,
Bangor, UK
J Clin Psychiatry 2000;61 Suppl 6:18-23


ABSTRACT

Early reports of the discovery of antidepressants in the 1950s have remained as little-known findings. Had the discovery of isoniazid, an agent with no clear action on monoamine systems, and that of reserpine, which depletes monoamines, been more widely known, then the monoamine lesion theories of depression, as proposed by Schildkraut in 1965, may not have been written. If the lesion in depression is lowered brain monoamine levels, then antidepressant agents that increase monoamine levels should work for all patients. If this were the case, optimizing treatment effect sizes with a minimum of side effects and some demonstrable specificity to depressive disorders would be possible. This is not the profile of antidepressants in clinical practice. Alternatively, if antidepressants act on constitutional types to provide appropriate therapeutic principles, then the efficacy would stem from an ability to suppress symptoms and to elicit or maintain conditions that allow recovery in a subgroup of patients who would otherwise remain nonresponsive. Current monoamine selective antidepressant principles embody "get-up-and-go" (noradrenergic) and emotional reactivity-reducing (serotonergic) principles. Different antidepressants are, therefore, likely to have different treatment effect sizes in different constitutional types. A further important aspect of antidepressant selectivity will lie in the extent to which these agents promote a sense of well-being during the maintenance phase of treatment.
TCAs
SSRIs
RIMAs
Options
Relapse
Bupropion
Amineptine
Reboxetine
Nefazodone
Mirtazapine
Venlafaxine
21st Century
Antidepressants
Chronic depression
Atypical depression
Retarded depression
Antidepressant metabolism
Antidepressants: new indications
Antidepressants: adverse effects
Antidepressants and the genome
Antidepressant augmentation strategies
Depression: recent developments and controversies
An historical analysis of the creation of the concept of an antidepressant


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