PHARMACOTHERAPY FOR MAJOR DEPRESSION WITH MELANCHOLIC FEATURES - RELATIVE EFFICACY OF TRICYCLIC VERSUS SELECTIVE SEROTONIN REUPTAKE INHIBITOR ANTIDEPRESSANTS

The effectiveness of tricyclic antidepressants (TCAs) and selective se rotonin reuptake inhibitors (SSRIs) were contrasted in endogenous/mela ncholic depression. By reviewing Hamilton Depression Rating data from controlled trials, the data indicate that TCAs are consistently more e ffective than the SSRIs, Despite the wide use of SSRIs in the treatmen t of depression, it seems reasonable that clinicians subtype their dep ressed patients and treat melancholic patients first with a course of TCAs. For melancholic patients who have not responded to a SSRI, pharm acotherapeutic alternatives include (1) a. TCA alone; (2) TCA augmenta tion of the SSRI, or (3) lithium augmentation of the SSRI.