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Choosing an antidepressive


The British National Formulary (BNF) lists over 30 generic preparations for the treatment of depression and still more are likely to be introduced within the next-year. These drugs were originally classified into two groups based on pharmacological differences considered important to their mode of antidepressive action; the monoamine oxidase inhibitors (MAOIs) and the tricyclic antidepressives (TCAs). This division copes poorly with many of the newer preparations and the classification in the current BNF now includes four headings: “TCAs and related drugs”, “MAOIs”, “Compound preparations” and “Others”. Unfortunately this rather arbitrary extension overlooks the important pharmacological developments of the newer drugs and gives little help on how to choose an antidepressive for an individual patient. This article attempts to establish guidelines for selecting an antidepressive.

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  • * The term “antidepressive” is preferred to “antidepressant” because these drugs do not antagonize depressants (i.e. drugs depressing the nervous system), but are active in depressive illness.