Psychiatria pre prax 3/2016

Some issues of antidepressant efficacy and tolerability relevant for routine clinical practice

Current possibilities of available antidepressants (AD) are limited. In spite of great heterogeneity of depressive disorders, monoamines remain the main target of psychopharmacotherapy. The differences in treatment response are associated with genetic variability. The developing field of pharmacogenetics strives for individualized treatment; however, in routine clinical practice the choice of antidepressant is based on individual efficacy, tolerability and alignment of symptoms to a biochemical alteration. The presence of an adequate quantity of the active substance in CNS targets is undoubtedly a precondition for efficacy. This raises the issue of adherence. The most frequent reasons for non-adherence are insufficient efficacy, including residual symptoms, as well as side effects, particularly sexual dysfunction, and weight gain. Attitudes to treatment may also play a significant role.

Keywords: antidepressants, side effects, adherence, attitudes to treatment