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Episode 16: Anti-Depressants: Is there a Drug of Choice?

In episode 16 we look at initiating treatment for depression. We briefly review screening and the diagnosis of depression before discussing the non-drug treatment options (therapy, exercise, sleep hygiene). We search for the anti-depressant of choice (being any) and end up deciding to tailor the choice based on factors such as side-effect profile, targeted symptoms, and cost. Although we stress the importance of regular follow-up, James refuses to come to see Mike or Adil.

Show Notes

1) Two screening questions for depression – do you feel depressed, do you have little interest in doing things

BMJ 2003; 327:1144-46

J Gen Intern Med. 1997;12:439-45

2) Benefit seen in 1 week with antidepressants

Arch Gen Psychiatry 2006;63:1217-23

3) No difference between the second generation antidepressants in effect

Ann Intern Med. 2005;143 :415-26

4) Weight benefit with fluoxetine.

Arch Intern Med 2004;164:1395-1404

5) Amitriptyline is as effective as other tricyclics or newer agents

Cochrane Library

6) Monitoring form for using antidepressants in children and adolescents

7) Clinical tool to monitor antidepressant treatment

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