Anxiety Depression Treatment

Antidepressants and melancholic depression

The older Tricyclics (TCAs) and Irreversible Monoamine Oxidase Inhibitors (MAOIs) appear to be more effective than the SSRIs for melancholic and psychotic depression, but tend to have more side-effects. The effectiveness of a number of the other, newer antidepressants for these depressive sub-types is less clear. Some may be too refined in their action, unlike the first-generation antidepressants, which impact on multiple neurotransmitters. Unfortunately, their impact on multiple neurotransmitters also increases the range of possible side effects. The first generation antidepressants have also been shown to be more effective in older patients, those who have had multiple episodes and when PMD is severe.

It would be reasonable for an individual with a first episode of melancholic depression to be commenced on an SSRIs or a Serotonin and Noradrenaline Reuptake Inhibitor (SNRI). If treatment is successful, it can be recommenced for any subsequent episodes. If this first-line treatment fails, then TCAs and MAOIs should be considered.

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