The strategy and tactics of choosing a particular method of pharmacotherapy in psychiatric practice are mainly determined by the disease itself, the presence of comorbidities, and the risks of negative side effects. As in any field of medicine, in psychiatry, it is also necessary to take into account the entire complex of drugs that the patient takes. This is due to the fact that their mutual action can lead not only to a change in the nature of the effects of each of them but also to the occurrence of undesirable consequences.
To the most widely used class of antidepressants belong the selective serotonin reuptake inhibitors (SSRIs), such as citalopram, escitalopram, fluoxetine, paroxetine, and sertraline. Chiarotti et al. (2017) supply that “antidepressant drugs are the current standard treatment for major depressive disorder, and among these, selective reuptake inhibitors (SSRIs) are the most commonly prescribed” (p. 1). Then, there are the mood stabilizers – among them, lithium, carbamazepine, clozapine, valproate, and lamotrigine are the most popular. Van Westrhenen et al. (2020) even state that “therapeutic drug monitoring of drug plasma levels has been used in psychiatry for a long time, in particular for tricyclic antidepressants, lithium, and clozapine.” (p. 7).
This is due to the fact that these drugs are usually used to treat bipolar disorder and avoid episodes of mania. In addition, antipsychotic drugs can often be prescribed as side medication for both depression and bipolar disorder treatment. In this category, aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone are used most often. Stahl (2014) claims that “olanzapine is often combined with fluoxetine to boost olanzapine’s antidepressant actions in treatment-resistant and bipolar depression” (p. 162). However, the use of antipsychotics for depression treatment is has proven to be controversial yet.
Chiarotti, F., Viglione, A., Giuliani, A., & Branchi, I. (2017). Citalopram amplifies the influence of living conditions on mood in depressed patients enrolled in the STAR*D study. Translational Psychiatry, 7(3). Web.
Stahl, S. M. (2014). Stahl’s essential psychopharmacology. Cambridge University Press.
van Westrhenen, R., Aitchison, K. J., Ingelman-Sundberg, M., & Jukić, M. M. (2020). Pharmacogenomics of antidepressant and antipsychotic treatment: How far have we got and where are we going? Frontiers in Psychiatry, 11. Web.