Highlights
Treatment Guidelines for Second-Generation Antidepressants
In 2008, the American College of Physicians (ACP) released practice guidelines for using second-generation antidepressants to treat major depression in adults.
These medications include selective serotonin-reputake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro) and other newer antidepressants such as buproprion (Wellbutrin), duloxetine (Cymbalta), mirtazapine (Remeron), and venlafaxine (Effexor). Studies indicate that these drugs do not differ much in effectiveness, although they may differ in terms of side effects.
The ACP recommends that doctors:
- Select these drugs on the basis of side effect profile, cost, and patient preference.
- Evaluate regularly a patient’s response to the drug therapy, beginning within 2 weeks after starting medication.
- Modify treatment by increasing dosage or switching drugs if the patient does not improve within 6 - 8 weeks after starting drug therapy.
- Continue drug treatment for 4 - 9 months if a patient with a first episode of major depression shows improvement. Treatment for more than 9 months may be recommended for patients who have had 2 or more episodes of depression.
Drug Treatment Guidelines for Pregnant Women
In 2008, the American College of Obstetricians and Gynecologists (ACOG) released clinical practice guidelines on the use of psychiatric medication during pregnancy and breastfeeding. ACOG recommends that:
- Pregnant women with depression receive care from a multidisciplinary team that includes an obstetrician, primary care docor, and mental health clinician.
- Doctors should evaluate a patient’s severity of illness to determine whether she needs to take medication during pregnancy.
- Paroxetine (Paxil) should not be prescribed during pregnancy, due to its risk for causing birth defects. Other selective serotonin-reuptake inhibitors (SSRIs) are not considered to have major risks for birth defects, and appear safe to use during breastfeeding.
