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Advances in Psychiatric Treatment (2005) 11: 184-194
© 2005 The Royal College of Psychiatrists

Newer v. older antidepressants in long-term pharmacotherapy

REVISITING... PREVENTION OF RELAPSE AND RECURRENCE OF DEPRESSION

J. Guy Edwards

Guy Edwards is Emeritus Consultant Psychiatrist at the Royal South Hants Hospital (Brintons Terrace, Southampton SO14 0YG, UK. E-mail: jguyedwards{at}gmail.com) and Visiting Professor in the Faculty of Medicine, Prince of Songkla University, Thailand. He was the Founding Editor-in-Chief of the journal Human Psychopharmacology. The author has in the past received research grants and lecture fees from, and been invited to national and international meetings by, the manufacturers of both older and newer antidepressants.

There is much evidence from clinical trials that antidepressants help prevent relapse and recurrence of major depression. However, this is unlikely to hold true for all patients with depression, particularly those treated in primary care. Individual antidepressants are equally efficacious, so choice (as first-line treatment in general or for individual patients) is largely determined by differences in side-effects, even though many of these disappear during long-term treatment, owing to adaptation. Specific effects that are considered in choosing a drug include those on cognition, psychomotor performance and sexual function; drug interactions, lethality in overdose and the potential for teratogenicity are also considered. There are insufficient entirely objective and generally accepted data on pharmaco-economics to allow for confident recommendations on drug choice for long-term treatment. Drug acquisition costs must be considered by those with restricted budgets, and especially patients in developing countries where difference in cost between newer and older drugs can be translated into more food for a hungry family.




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Copyright © 2005 The Royal College of Psychiatrists.