Clinical indications for the use of antidepressants: diagnostic criteria

The use of antidepressants should be carefully indicated based on a thorough clinical evaluation using established diagnostic criteria.

According to the current international classification, the diagnosis of a depressive episode requires the presence of certain affective, cognitive, and somatic symptoms that significantly alter the individual's functioning. The three core symptoms are: (1) depressed mood most of the day, (2) anhedonia or loss of interest in pleasurable activities, and (3) decreased energy or constant fatigue.

These symptoms must be present for at least two weeks and cause significant functional impairment. Additional symptoms include cognitive slowing, feelings of worthlessness or excessive guilt, suicidal ideation, sleep disturbances (insomnia or hypersomnia), changes in appetite, decreased libido, and somatic complaints such as headache or gastrointestinal discomfort.

The severity of the episode is determined by the number of symptoms present: mild (4-5), moderate (6-7), or severe (more than 8), which guides the type of therapeutic intervention.

Severe depression and criteria for pharmacological treatment

In cases of mild depression, the first line of intervention usually focuses on psychotherapeutic strategies, psychoeducation, behavioral activation, physical exercise, and strengthening social support.

However, when the clinical picture reaches a moderate or severe level, the initiation of pharmacological treatment is justified. First-line antidepressants include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, or escitalopram.

Dual inhibitors (such as venlafaxine), tricyclic antidepressants (such as amitriptyline), or specific noradrenergic agents may also be considered depending on the patient's response and tolerance.

In severe cases, especially when there are psychotic symptoms, persistent suicidal ideation, or severe functional impairment, pharmacological treatment should be started quickly, often in combination with other strategies such as hospitalization, give this content a title and tell me what it is about (hallucinations, delusions consistent with mood) marks a turning point in the indication for more complex treatments.

Resistant depression and augmentation strategies

A patient is considered to have resistant (or refractory) depression when remission has not been achieved after at least two different pharmacological treatments, at adequate doses and for a sufficient period of time. In these cases, augmentation strategies are used, which consist of combining the antidepressant with other medications to enhance its effect.

Options include atypical antipsychotics (aripiprazole, quetiapine, olanzapine), lithium