This evidence report clearly shows newer antidepressants are effective treatments for major depression and dysthymia. They are efficacious in treating depressive disorders in mental health as well as primary care settings. Newer antidepressants have similar efficacy and total dropout rates compared to older antidepressants. Because of similar efficacy, both newer and older antidepressants should be considered when making treatment decisions. When selecting antidepressants, clinicians should consider costs, the small but statistically significant differences in dropouts due to adverse effects, the lack of information about relative benefits compared to alternative therapies (e.g., psychosocial and herbal), and the individual patient's preferences and tolerance for particular adverse effects. Health policy planners should consider these factors and advocate for cost-effectiveness studies to better guide the allocation of health care dollars.
For patients with other forms of depression, such as subsyndromal or mixed anxiety depression, and for special populations, such as children and adolescents, data on newer pharmacotherapies are insufficient to guide treatment decisions. Clinicians who choose to generalize efficacy data from adult patients with major depression to such patients should do so with care.