Newer v. older antidepressants in long-term pharmacotherapy. Revisiting: Prevention of relapse and recurrence of depression

Abstract

There is much evidence from clinical trials that antidepressants help prevent relapse and recurrence of major depression. However, this is unlikely to hold true for all patients with depression, particularly those treated in primary care. Individual antidepressants are equally efficacious, so choice (as first-line treatment in general or for individual patients) is largely determined by differences in side-effects, even though many of these disappear during long-term treatment, owing to adaptation. Specific effects that are considered in choosing a drug include those on cognition, psychomotor performance and sexual function; drug interactions, lethality in overdose and the potential for teratogenicity are also considered. There are insufficient entirely objective and generally accepted data on pharmaco-economics to allow for confident recommendations on drug choice for long-term treatment. Drug acquisition costs must be considered by those with restricted budgets, and especially patients in developing countries where difference in cost between newer and older drugs can be translated into more food for a hungry family.