Psychiatria pre prax 5–6/2010

Pharmacotherapy in hospitalized depressed patients

Nowadays, we have at our disposal a large spectrum of antidepressants; however, only in a part of patients a remission is achieved. One of the reasons, undoubtedly, is the fact that depressive disorder represents a very heterogeneous group. We have no robust markers of the disease and the diagnosis is based on the number and to a certain degree on the severity of the symptoms. In clinical trials an important inclusion criterion is a score of the evaluation scales. In a common, especially out-patient clinical practice, we are using a more general evaluation of the treatment effect. Among newer ADs there are differences not only in tolerability but also efficacy. Effect of AD again placebo is increasing with the severity of depression. These findings have not yet been taking into consideration in the contemporary recommended guidelines.

Keywords: severe depression, diagnosis, treatment, efficacy, tolerability.