Pharmacological management of unipolar depression

Objective To be used in conjunction with Psychological management of unipolar depression' [Lampe etal. Acta Psychiatr Scand 2013;127(Suppl. 443):2437] and Lifestyle management of unipolar depression' [Berk etal. Acta Psychiatr Scand 2013;127(Suppl. 443):3854]. To provide clinically relevant recommendations for the use of pharmacological treatments in depression derived from a literature review. Method Using our previous Clinical Practice Guidelines [Malhi etal. Clinical practice recommendations for bipolar disorder. Acta Psychiatr Scand 2009;119(Suppl. 439):2746] as a foundation, these clinician guidelines target key practical considerations when prescribing pharmacotherapy. A comprehensive review of the literature was conducted using electronic database searches (PubMed, MEDLINE), and the findings have been synthesized and integrated alongside clinical experience. Results The pharmacotherapy of depression is an iterative process that often results in partial and non-response. Beyond the initiation of antidepressants, the options within widely used strategies, such as combining agents and switching between agents, are difficult to proscribe because of the paucity of pertinent research. However, there is some evidence for second-line strategies, and a non-prescriptive algorithm can be derived that is based broadly on principles rather than specific steps. Conclusion Depression is by its very nature a heterogeneous illness that is consequently difficult to treat. Invariably, situation-specific factors often play a significant role and must be considered, especially in the case of partial and non-response. Consulting with colleagues and trialling alternate treatment paradigms are essential strategies in the management of depression.