Lead editorial – Major depressive disorder
Professor Stuart A Montgomery
Emeritus Professor of Psychiatry, Imperial College School of
Medicine, London
Major depressive disorder (MDD) is highly prevalent and is the prime disorder in the Western world that severely impairs the ability to function during active working life. It is also a life-threatening disorder due to suicide and a wide range of physical disorders if depression is present.
Clinicians fail to appreciate the compelling data that show antidepressants are potent medications with robust efficacy in the treatment of moderate-to-severe depression.
It is clear that antidepressants are effective, both in short-term and in long-term treatment and that treatment reduces the disability associated with MDD and improves quality of life. It is surprising therefore that in the UK antidepressants continue to be underprescribed and that, when they are prescribed, the mean duration of treatment is much shorter than the minimum recommended.
Troublesome side-effects such as nausea and sexual side-effects with some antidepressants are well known. They are also associated with the development of the discontinuation syndrome when treatment is interrupted. There is generally a delay after initiation of treatment with an antidepressant before the clinical benefit is seen. If the antidepressant is difficult to tolerate, and some are, the side-effects experienced, combined with a generally slow onset of effect, are likely to compromise adherence with treatment to achieve benefit. Improvement in the tolerability of antidepressants and decreasing the time to apparent onset of effect are areas which would considerably benefit patients.
Progress has been made in addressing different mechanisms of action for the development of better tolerated antidepressants that lack troublesome discontinuation effects, and in identifying improved efficacy. What is needed is a better recognition of the dangers and disabilities associated with MDD and an unbiased appreciation of the major advances that have been achieved in its treatment.