Antidepressant selection: proceedings from a TCA/SSRI Concensus Conference.

Abstract

Despite significant advances in treatment choice, the use of antidepressants in clinical practice remains far from optimal. One aspect of antidepressant use, initial antidepressant selection, is the most immediately influential way to improve clinical outcomes. The purpose of this conference was to review the available literature on the two most common classes of antidepressants--the tricylic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs)--and come to consensus on recommendations for initial antidepressant selection. A panel of experts in psychiatry and health services research was convened to systematically review and discuss the available literature on the TCAs and SSRIs in the treatment of depression and related affective disorders. The consensus group concluded that growing evidence suggests that TCAs are no longer justified as first-line antidepressant therapy in most settings. In addition, emerging differences in the tolerability profiles and breadth of indication of the SSRIs are important to consider when making an initial treatment choice. While the coming years will bring new treatment options, clinicians currently have the ability to improve clinical outcomes and the long-term prognosis of depression. The following pages provide information to make informed antidepressant choices, thereby providing a higher quality of antidepressant treatment for the patient in actual clinical practice.