Current Antidepressant Therapy: A Critical Examination

Abstract

Depression remains a major health problem, resulting in an annual economic burden in the hundreds of billions of dollars. This article reviews the limitations of current treatments for depression, including first-line therapies as well as methods used for treatment-refractory depression (TRD). Antidepressant medication remains the most common method of therapy, yet, compared to medications for nonpsychiatric conditions, antidepressants have a relatively low response rate, high relapse rate, and long time to response, as well as side effects that limit tolerability or contribute to poor compliance. Furthermore, there is no definitive algorithm in place or method to ascertain what pharmacologic options will be the most effective for a patient, regardless of whether they are treatment-naïve or have TRD. Electro-convulsive therapy (ECT) remains an effective option for TRD but is limited by availability and risks of short-term cognitive impairment. Although better tolerated, current data suggest newer neurostimulation therapies have yet to offer anything as efficacious as ECT or more convenient than antidepressant medication. Although psychotherapy is often recommended as a first-line option, there are many actual and perceived barriers in today’s society that prevent its use when indicated. Factors that hinder effective treatment common to all modalities include cost, public and individual stigma, inconsistent measuring of illness severity and treatment response, and limited knowledge of the genetic variances among patients. The authors of this article conclude that more novel approaches to treatment must be investigated in the hopes of finding solutions that can overcome these barriers. [ Psychiatr Ann . 2015;45(9):456–462.]