Treatment of Acute Major Depression and Dysthymia -Guidelines

Pharmacologic Treatment of Acute Major Depression and Dysthymia

For primary care patients with acute major depression or dysthymia, including elderly persons without significant comorbid conditions, physicians should consider either tricyclic antidepressants or newer antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), as equally efficacious treatments. For short-term treatment of mild acute depression, St. John's wort may be considered, but patients should be cautioned that this treatment is not approved by the U.S. Food and Drug Administration and that preparations may vary substantially from those tested in randomized trials.
Because older and newer antidepressants are equally efficacious, the physician and patient should jointly review the adverse effect profiles of both drug classes so that an agent that fits the clinical needs of the patient can be chosen.
Antidepressant medication should be continued at the same dose for at least 4 months beyond initial recovery or improvement to decrease the probability of short-term relapse. If at 6 weeks a patient shows no response or a poor response to an adequate dose of antidepressant medication, treatment should be changed.
Physicians should ensure that every instance of a serious adverse effect is accurately reported to the U.S. Food and Drug Administration in a timely manner, either through their Web site at www.fda.gov/medwatch/report/hcp.htm, by telephone at 800-FDA-1088, or by fax at 800-FDA-0178.

NOTE: You should always check with your doctor before making any changes in your medications.

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