It is worth remembering that antipsychotics and antidepressants were shown to be effective (to just about everyone’s satisfaction) without the ‘advantage’ of randomized, controlled trials. Each paper, in its own way, calls for better integration of evidence-based ideals with clinical observation.
The International Classification of Diseases 10 [World Health Organization, 1992] characterizes depression Inhibitors,research,lifescience,medical by three core symptoms: low mood, anhedonia and low energy levels. Other symptoms include reduced concentration and self-esteem, ideas of self-harm, disturbed sleep and diminished appetite, which must persist for 2 weeks minimum. Variation in symptomatology Inhibitors,research,lifescience,medical distinguishes
between mild, moderate and severe depression. In regards to management, antidepressants are first-line
treatment for moderate and severe depression, whereas ‘watchful-waiting’, exercise and problem solving are recommended for mild depression [Anderson et al. 2008]. The serendipitous discovery that iproniazid and imipramine elevate mood implicated a central role of the monoamine system in depression pathology. Thus, all commercially available antidepressants increase levels of serotonin (5HT), norepinephrine (NE) and/or dopamine (DA) via different therapeutic mechanisms. First-generation antidepressants include tricyclic Inhibitors,research,lifescience,medical antidepressants (TCAs) Inhibitors,research,lifescience,medical and monoamine oxidase inhibitors (MAOIs), however they frequently possess undesirable side-effects, and toxic effects in overdose, limiting their application. click here Newer-generation antidepressants, including the well-known
selective serotonin reuptake inhibitors (SSRIs) are more selective and offer improved safety and tolerability (see Table 1 for a selective review of antidepressants; note, however, that this table does not represent an exhaustive review of the antidepressants currently available [Gelder et al. 2006]). Table 1. Review of antidepressants: therapeutic mechanism and side-effects. Efficacy of antidepressant: a picture of bliss Clinical Inhibitors,research,lifescience,medical trials provide compelling evidence for antidepressant effectiveness, with thousands of positive trials over the past five decades [Hollon et al. 2002]. Randomized controlled trials (RCTs) are the PDK4 gold-standard methodology for assessing efficacy, in which patients are assigned in a double-blind fashion to a placebo (inert ‘sugar pill’) or active-drug group. Meta-analyses of RCTs typically report antidepressants as 20–30% more effective than placebo, with higher response rates (50% reduction in Hamilton Depression Rating Scale [HDRS] scores) and improved remission rates (HDRS score of less than 
[Davis et al. 1993; Walsh et al. 2002; Arroll et al. 2005]. Meta-analyses indicate antidepressant effectiveness varies as a function of symptom severity, with greatest efficacy in severe depression.