title: Pharmacological management of unipolar depression.
abstract: OBJECTIVE
  To be used in conjunction with 'Psychological management of unipolar depression' [Lampe et al. Acta Psychiatr Scand 2013;127(Suppl. 443):24-37] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of pharmacological treatments in depression derived from a literature review.
  
  
  METHODS
  Using our previous Clinical Practice Guidelines [Malhi et al. Clinical practice recommendations for bipolar disorder. Acta Psychiatr Scand 2009;119(Suppl. 439):27-46] as a foundation, these clinician guidelines target key practical considerations when prescribing pharmacotherapy. A comprehensive review of the literature was conducted using electronic database searches (PubMed, MEDLINE), and the findings have been synthesized and integrated alongside clinical experience.
  
  
  RESULTS
  The pharmacotherapy of depression is an iterative process that often results in partial and non-response. Beyond the initiation of antidepressants, the options within widely used strategies, such as combining agents and switching between agents, are difficult to prescribe because of the paucity of pertinent research. However, there is some evidence for second-line strategies, and a non-prescriptive algorithm can be derived that is based broadly on principles rather than specific steps.
  
  
  CONCLUSIONS
  Depression is by its very nature a heterogeneous illness that is consequently difficult to treat. Invariably, situation-specific factors often play a significant role and must be considered, especially in the case of partial and non-response. Consulting with colleagues and trialling alternate treatment paradigms are essential strategies in the management of depression.
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia. gin.malhi@sydney.edu.au
authors.forename: G S
authors.initials: GS
authors.lastname: Malhi
authors.forename: R
authors.initials: R
authors.lastname: Hitching
authors.forename: M
authors.initials: M
authors.lastname: Berk
authors.forename: P
authors.initials: P
authors.lastname: Boyce
authors.forename: R
authors.initials: R
authors.lastname: Porter
authors.forename: K
authors.initials: K
authors.lastname: Fritz
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D061218:Depressive Disorder, Treatment-Resistant / Q000209:etiology / Q000628:therapy; D016903:Drug Monitoring / Q000379:methods; D055317:Evidence-Based Practice; D006801:Humans; D055118:Medication Adherence; D054539:Medication Therapy Management; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents