Objective: To review the tricyclic antidepressants, selective serotonin reuptake inhibitors, and dually acting antidepressants and their economic and treatment implications.
Summary: Major depressive disorder.s cost to the U.S. economy is staggering, but the selection of drugs available to treat it has expanded to include drugs that have better side-effect profiles. Regardless, remission rates are high, and, often, patients are not treated aggressively enough. Somatic presentations are more common than previously thought, and pain, in particular, may be associated with depression. Pain and depression are both regulated by serotonin and norepinephine, and several studies suggest that using dual-action antidepressants may be helpful in patients who have an element of pain to their disorder. Titration to an adequate dose of any antidepressant is important, as is sustaining treatment for months to years, depending on the patient.s history.
Conclusion: Increasingly, the mental health community is realizing that the goal of treatment for patients with major depressive disorder must be sustained remission.