Prescribing pharmacotherapy for major depressive disorder: how does a clinician decide?

What is it about?

Selection of treatment according to evidence-based medicine relies primarily on randomized controlled trials and meta-analyses. However, this evidence applies to the “average” patient and ignores the fact that standard classification systems do not include patterns of symptoms, severity of illness, effects of comorbid conditions, timing of phenomena, rate of progression of illness, responses to previous treatments, and other clinical distinctions that demarcate major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same diagnosis.

Featured Image

Photo by National Cancer Institute on Unsplash

Photo by National Cancer Institute on Unsplash

Why is it important?

A rational use of drugs depends on the balance of potential benefits and adverse effects applied to the individual patient. The clinician needs to have a clear account of the potential benefits of a specific treatment, as well as of the predictors of responsiveness, and of the potential adverse events that may be triggered by the therapeutic act, which might include side effects and iatrogenic effects. These aspects can only be appraised by clinical judgment, which derives by a refined and comprehensive assessment, and not simply by comparing treatment options for the average patient in the treatment of the acute episode of depression and in prevention of relapse, as it occurs with clinical guidelines.

Perspectives