ABSTRACT
Over the last several decades, an increasing number of effective pharmacological and nonpharmacological treatments for depression have become available, including antidepressants, electroconvulsive therapy (ECT), timelimited psychotherapies, and investigational treatments. The efficacy of these treatment modalities, particularly the use of antidepressants, for the acute, continuation, and maintenance phases of treatment has been well established in the literature.When choosing a treatment for depression, the clinicianmust consider all factors (acute and long term) that will optimize efficacy, tolerability, safety, and adherence. Common factors that are frequently overlooked include dosing schedule (once per day vs twice or three times per day), the cost of treatment (for uninsured patients or those forced to pay ‘‘out-ofpocket’’), and possible long-term side effects. The profile of the ideal antidepressant would include (1) efficacy in acute and long-term treatment,
(2) well tolerated during both acute and long-term treatment (clinicians must remain cognizant of the fact that side effects of some medications may occur later when the patient is feeling better), (3) acute and long-term safety (including treatment of comorbid illness), and any factors that the clinician believes could be individualized to the patient that may impact adherence to treatment.
