Currently, pharmacotherapy is the primary treatment modality for depression. Various classes of antidepressants have been developed and are widely used at present. Although the antidepressant effects of these drugs are thought to be similar, there are numerous differences between drugs in pharmacologic characteristics, side effects, and tolerabilities. Furthermore, 40~50% of patients may not respond sufficiently to the first-line antidepressants they take. As the response rates are substantially insufficient, and the side effects are not uncommon, the optimal treatment of antidepressants is somewhat difficult. Therefore, the clinicians treating depression should understand the characteristics of various antidepressants and also the optimal treatment strategy. In this review, we introduce various antidepressants and optimal treatment strategies for the treatment of depression.
Antidepressive Agents ; Depression ; Humans

Filipino traditional healers have been using Centella asciatica (L.), locally known as "takip-kuhol", as a stimulant and brain tonic. Coloma et al found its leaf decoction comparable to Fluoxetine in decreasing immobility time in mice with induced depression. Objectives: This study was then conceived to establish antidepressant properties of Centella asciatica (L.) (takip-kuhol) leaf extract in a mice model using a systematic purification of leaf extract and comparing it with Fluoxetine, a known antidepressant. Method: This is a single blind experimental study using completely randomized design wherein Centella asciatica (L.) (takip-kuhol) leaves were percolated in 60 percent ethanol, then evaporated to extract a purified form. Effective antidepressant dose50 (ED50) was determined using the Forced-swimming test. Centella asciatica (L.) (takip-kuhol) ED50 was then compared with Fluoxetine 10 mg/kg and NSS 0.1 ml. to establish antidepressant properties through measurement of immobility time in the Forced-swimming test. ED50 of Centella asciatica (L.) (takip-kuhol) was found to be 37.8 mg/kg. Results: It was noted to be statistically comparable to Fluoxetine 10 mg/kg in improving immobility time at t0.05 of 2.101 and F0.05 of 3.39 (t=0.24 and F=0.09). Both Fluoxetine 10 mg/kg and Centella asciatica (L.) (takip-kuhol) 37.8 mg/kg were found to be statistically not comparable to NSS 0.1 ml at these levels (t=3.89 and 4.97, respectively and F=14.72 and 17.11, respectively). Conclusion: Hence this study concludes that Centella asciatica (L.) (takip-kuhol) has comparable antidepressant properties as Fluoxetine 10 mg/kg in mice, and is better than placebo in improving induced depression.
PLANTS, MEDICINAL ; ANTIDEPRESSIVE AGENTS

Objective: This case report highlights antenatal depression as a common condition with potentially grave outcomes if left untreated. However, treatment options can be limited by the need to protect the fetus from medication-induced side effects. Methods: We report a young female obstetric patient who was carrying twins conceived through assisted reproduction, and her pregnancy was complicated by placenta previa major and repeated antepartum hemorrhages, which necessitated multiple admissions and strict bed rest. She became intensely depressed and anxious, developed suicidal ideation and refused examinations that were necessary to her physical health. She was referred to a psychiatrist and was given low-dose medication, supportive counseling, and case management. Results: She responded well to treatment, showing marked improvement in her mood and cooperation with obstetric care. Her twins were delivered at 35 weeks’ gestation in good health. Her progress was maintained into the postpartum period. Conclusions: This case of antenatal depression was successfully treated using a combination of medication, case management and psychological support. It adds to evidence that this illness benefits from early identification and is highly treatable.
Pregnancy, High-Risk ; Antidepressive Agents

Newer antidepressants of various types continue to be developed for the treatment of depression recently. While the physicians have a good chance of choosing the diverse antidepressant, they have difficulties to select an appropriate antidepressant. Factors to consider when choosing an antidepressant include the efficacy, adverse effects, age of the patients, subtype of depression, prior response to antidepressant and pharmacoeconomics. The issues of selecting antidepressant will be discussed in this article.
Antidepressive Agents* ; Depression ; Economics, Pharmaceutical ; Humans

OBJECTIVES: A significant number of cancer patients experience depressive disorders. Numerous studies have demonstrated that depression in such patients is under-diagnosed and inadequately treated, due to various factors. One of these factors is a lack of an evidence supporting the use of antidepressants in cancer patients. The aim of this systematic review was to establish the evidence for the pharmacological treatment of depression in this population. METHODS: We searched Korean domestic and international database using the keywords "cancer", "depression", and "pharmacological treatment", limiting the search to articles published between 1980 and 2008 and grading the reviewed studies' quality according to Scottish Intercollegiate Guideline Network (SIGN) methodology. RESULTS: Of 283 studies searched, 28 studies were appropriate for review. CONCLUSION: The evidence for the pharmacological treatment of depression was limited. However, based on available literature, it seems the newer antidepressants are better tolerated and can be continued safely, with satisfactory efficacy, in cancer patients. Further well-designed, long-term follow-up studies should be conducted.
Antidepressive Agents ; Depression ; Depressive Disorder ; Humans

Some new antidepressants including mirtazapine and citalopram appear to have promising efficacy and tolerability in the treatment of depression. For most major depression, all antidepressant drugs have equal efficacy. The choice of antidepressant drug needs to be tailored to a particular patient's medical condition and personal preferences. It is likely that adverse effects are the major determinant in the choice of antidepressant for a particular patient. However, in treating conditions other than depression, the efficacy of the ntidepressant drug can be the primary issue of drug choice. In conclusion, we would like discuss the current status and future direction in the treatment of depression.
Antidepressive Agents ; Citalopram ; Depression* ; Drug Therapy* ; Humans

The serotonin has been known to play important roles in pathology of the mood disorders. We summerize the evidences of serotonin in pathology of the mood disorders in a view of neuroanatomical and neurochemical aspects. Nowaday, the selective serotonin reuptake inhibitors(SSRIs)may be practically the first line of antidepressants with traditional tricyclic antidepressants(TCAs. Authors review the role of serotonin in the treatment of the mood disorders, in a view of the general considerations in selecting antidepressants, pharmacology, therapeutic, indications, side effects, doses of medication, drug-discontinuation syndrome, drug-to-drug interactions, and special therapeutic situations.
Antidepressive Agents ; Mood Disorders* ; Pathology* ; Pharmacology ; Serotonin*

OBJECTIVE: The present study aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) at a high frequency using a miniaturized device compared to standard rTMS and sham rTMS for the treatment of depression. METHODS: Fifty-four patients with depression were randomly assigned to either 15 days of miniaturized, standard, or sham rTMS. The stimulation consisted of 60 trains of 5 seconds at 10 Hz for 30 minutes. Clinical measures were assessed at baseline and on the final day of the stimulation. RESULTS: A repeated-measures analysis of variance revealed a significant main effect of time and a time by group interaction on Hamilton Rating Scale for Depression scores. There were no significant correlations between individual motor thresholds and changes of clinical outcomes. Our results revealed a significant reduction in the Hamilton Rating Scale for Depression in the miniaturized and standard groups compared to the sham group. CONCLUSION: The antidepressant utility of miniaturized rTMS using subthreshold stimulation was comparable to that of standard stimulation.
Antidepressive Agents ; Depression ; Humans ; Transcranial Magnetic Stimulation

Antidepressive Agents/pharmacology* ; Depression/drug therapy*

Depressive illness is a major public health problem with important medical, social and economic implications. The efficacy of various antidepressants in treating depression has been demonstrated in randomized controlled trials (RCTs). However, these studies do not adequately address the complexities of clinical practice. Although most of RCTs assumed there was no difference in efficacy between the tricyclic antidepressants (TCAs) and serotonin specific reuptake inhibitors (SSRIs), naturalistic studies show that patients who take TCAs often receive subtherapeutic doses for inadequate duration than those with SSRIs. Because the benefits of the implementation of current guidelines are limited, the optimal choice of medication must be guided by detailed history and careful consideration of the real-world efficacy of antidepressants and long-term health care costs.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Depression ; Health Care Costs ; Humans ; Public Health ; Serotonin