Selecting an Antidepressant Agent

1. All antidepressant drugs have shown equal efficacy, but they have different side-effect profiles.

2. There is no reliable method of predicting which patients will respond to a specific antidepressant based on clinical presentation.

3. If the patient or a first-degree relative has had a previous treatment response to a given medication, another trial of that medication is indicated.

4. Agent selection is also based on the expected tolerance to side effects, the patient's age, suicide potential, and any coexisting diseases or medications.

a. Studies suggest that selective serotonin reuptake inhibitors (SSRIs) are much safer in patients with a history of cardiac disease.

b. SSRIs are safer than heterocyclic antidepressants in overdose, making them preferable for suicidal patients.

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