Antidepressant drugs-State of the art

Abstract

Due to their frequency, complications, and sequelae, depressive disorders are of great significance to patients, their environment, and society. They are considered the most frequent form of mental disturbances in old age. The use of antidepressant drugs (AD) represents a cornerstone of the treatment, which is always multidimensional. The classification, mechanism of action, efficacy and tolerability of AD are described. Furthermore, the practical treatment procedure as well as special aspects, such as treatment resistance and special features in old age are presented. Narrative review incorporating the most recent literature and the new edition of the national healthcare guidelines on unipolar depression. In the past 20years, alarge number of so-called 2nd generation ADs have been approved worldwide with comparable efficacy but more favorable side effect profiles than conventional (tricyclic) substances. Almost all ADs act by enhancing monoaminergic, mostly serotonergic, neurotransmission. Other common features include alatency in the onset of action, moderate response rates, and potential efficacy on all core symptoms of depression. Side effects can include cardiovascular, metabolic, or sexual dysfunction, but these may significantly differ between drug classes. This enables individualized treatment taking age, individual risk factors, comorbidities and comedications into account. With the correct interpretation of indications, knowledge of the risks, and consideration of the defined precautionary measures outlined here, treatment with AD is asafe and effective tool in the treatment of moderate and severe depression.