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Antidepressants: Their efficacy and place in therapy

University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK

This paper reviews and relates to the wider published literature a series of studies directed to the broad question of which antidepressant treatment is required for which kind of depressed patient. Adequate methodology requires comparisons with placebo and other active drugs, rather than analysis of single treatment groups, so that the magnitude of therapeutic benefit due to specific drug effects can be measured. Reasonably firm conclusions are now possible. Electroconvulsive therapy (ECT) is most effective in severely depressed patients, particularly those with delusions or retardation, and is superior to antidepressant drugs in such patients. Monoamine oxidase (MAO) inhibitors show some selectivity towards patients with anxiety or reversed functional shift symptoms, but this selectivity appears quite limited, and tricyclic antidepressants also benefit such patients. The possibility of other factors, not well reflected in clinical features, which determine consistency of response requires further investigation. Recent evidence has led to re-evaluation of the earlier view that tricyclic antidepressants were specifically indicated in endogenous depressions. They appear to be broad-spectrum antidepressants, with efficacy extending more widely into neurotic disorders, mixed anxiety depressions, anxiety disorders, and into the relatively mild non-endogenous depressions of general practice.

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