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Optimising antidepressant use in clinical practice: towards criteria for antidepressant selection

Department of Psychiatry, University of Brussels (Erasme Hospital, Route de Lennick 808, 1070 Brussels, Belgium; e-mail: jmendlew@ulb.ac.be; fax: +32 2 555 4515), and Laboratory of Psychiatry Research, Free University of Brussels

Declaration of interest J.M. received an honorarium and travel expenses from Eli Lilly & Co.

Background Current treatment for depression in primary care and other out-patient settings demonstrates a pattern that is incongruous with the magnitude of the burden of depression suggested by its associated disability.

Aims To review important considerations in current depression treatment with a focus on antidepressant use.

Method Factors influencing the undertreatment of depression in real-world settings are examined.

Results Patient and clinician behaviour as well as the incentives created by the health care system affect the likelihood of realising effective antidepressant therapy in practice.

Conclusions Given the complexities of clinical practice, selection criteria for an antidepressant should include safety, efficacy and tolerability, as well as the ability of the antidepressant to deliver real-world efficacy while balancing health care costs in the long term.