What is the first-line treatment for depression?

From the Guidelines

The first-line treatment for depression typically involves either psychotherapy or antidepressant medication, with selective serotonin reuptake inhibitors (SSRIs) being the most commonly prescribed medications, as recommended by the American College of Physicians 1. The treatment of depression can be characterized by three phases: acute, continuation, and maintenance.

• The acute phase typically lasts 6-12 weeks and involves the initiation of treatment.
• The continuation phase lasts 4-9 months and aims to prevent relapse.
• The maintenance phase lasts at least 1 year and aims to prevent recurrence. SSRIs, such as fluoxetine (Prozac) 20-80mg daily, sertraline (Zoloft) 50-200mg daily, escitalopram (Lexapro) 10-20mg daily, or citalopram (Celexa) 20-40mg daily, are usually the first medications prescribed and take 4-6 weeks to reach full effectiveness 1. These medications should be continued for at least 6-12 months after symptom improvement to prevent relapse. Side effects may include nausea, headache, sleep disturbances, and sexual dysfunction, which often improve over time. Patients should be monitored regularly, especially in the first few weeks of treatment, as recommended by the American College of Physicians 1. For optimal outcomes, treatment should be accompanied by lifestyle modifications such as regular exercise, adequate sleep, stress management techniques, and social support. If the first medication tried doesn't work after an adequate trial (usually 6-8 weeks), switching to another SSRI or a different class of antidepressant may be recommended, as suggested by the American College of Physicians 1. It is also important to note that various psychological interventions, such as cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapies, are effective in treating depression, as reported in a recent network meta-analysis 1.

From the FDA Drug Label

Sertraline treatment should be administered at a dose of 50 mg once daily. The efficacy of sertraline in the treatment of a major depressive episode was established in six to eight week controlled trials of adult outpatients whose diagnoses corresponded most closely to the DSM-III category of major depressive disorder

The first-line treatment for depression is Sertraline at a dose of 50 mg once daily 2.

• Key points:
  • The dose of sertraline for the treatment of major depressive disorder is 50 mg once daily.
  • The efficacy of sertraline was established in controlled trials of adult outpatients with major depressive disorder.
• Main idea: Sertraline is a first-line treatment option for depression, with a recommended initial dose of 50 mg once daily 2.

From the Research

First-Line Treatment for Depression

The first-line treatment for depression can vary depending on the severity of the condition and the individual patient's needs.

• According to a study published in 2023 3, second-generation antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are considered first-line therapy for depression.
• Psychotherapy, including cognitive behavior therapy (CBT) and other types of individual and group therapy, is also a first-line treatment for depression 3.
• A study from 2005 4 found that both interpersonal psychotherapy (IPT) and CBT can be as effective as medications in the acute treatment of depressed outpatients.
• The combination of medication and psychotherapy is often preferred for severe depression, as it can improve response and reduce the risk of relapse 3, 5.

Factors Influencing Treatment Choice

Several factors can influence the choice of treatment for depression, including:

• Severity of symptoms: More severe depressions may require combination treatment with medication and psychotherapy 5, 6.
• Treatment history: Patients who have not responded to previous treatments may require a different approach 7.
• Comorbidities: The presence of other medical or mental health conditions can impact treatment choice 3.
• Cost and risk of adverse effects: These factors should be considered when selecting an antidepressant medication 3.

Reducing Relapse Risk

To reduce the risk of relapse, it is essential to:

• Continue treatment for an adequate duration: Gradually tapering the dosage of medication while providing CBT can decrease the risk of relapse 3.
• Monitor for residual symptoms: The presence of residual mood spectrum symptoms can increase the risk of relapse 7.
• Consider combination treatment: Combining medication and psychotherapy can improve response and reduce the risk of relapse 4, 5.