Somatic therapy for major depressive disorder: selection of an antidepressant.

Major depressive disorder is a major health concern. It adversely affects the patient, the family, and society. While the consequences can be devastating and life-threatening, this condition has an excellent prognosis when properly identified and treated. Somatic therapy plays a pivotal role in inducing and maintaining a remission and preventing recurrent attacks. There are now five major classes of antidepressants which differ in terms of their clinical spectra of antidepressant activity, their safety and tolerability, their likelihood of pharmacodynamic and pharmacokinetic interactions with concomitantly prescribed drugs, ease of administration, and physician confidence, which is in large measure a reflection of the extent and quality of their human exposure database. The proper selection and management of antidepressant pharmacotherapy is based on an understanding of these differences.