It is impossible to recommend antidepressant effective for all patients.Sertraline (Zoloft) and escitalopram (Lexapro) are considered to have the best combination of efficacy and acceptability .
Tricyclics were developed after researchers began exploring derivatives of the first typical antipsychotic medication Thorazine.
Experimentation with derivatives lead to the development of the first TCA drug called “Imipramine.” Initially the drug Imipramine was not intended to treat depressive symptoms, but it was found to induce mania.
Should not be used to treat depression failed to respond to other SSRIs, but may be considered for people with severe depression who responded to other SSRIs but have been unable to tolerate side effects.
Worst side effects profile: weight gain, sexual dysfunction, sedation, and anticholinergic side effects! Significantly more problems on discontinuation than with other SSRIs.
Sertraline may be the best choice when starting treatment for moderate to severe major depression in adults because it has the most favourable balance between benefits, adverse effects, and acquisition cost.
Many psychiatric disorders are accompanied by disturbance of sleep.It is thought that all approved antidepressants work through modulation of monoamine neurotransmitters, including norepinephrine, dopamine, and serotonin, all of which have been shown to exert prominent effects in regulating sleep-wakefulness and sleep architecture (Table).TCAs Pharmacological differences among TCAs translate into clinically differentiating features.May elevate liver enyzmes, worsen narrow angle glaucoma, and cause urinary hesitancy. Unique antidepressant - most closely resembles the action of psychostimulants.Avoid in persons with history of epilepsy, seizures, head trauma, alcohol dependence. The Best Antidepressant First of all, antidepressant that is universally effective for everyone does not exist: many depressed patients do not experience a satisfactory clinical benefit from the initial treatment.Tricyclic Antidepressants (TCAs) were developed in the 1950s as a way to treat depression with chemical compounds.