Depression in the medically ill : choosing an antidepressant. Discussion

Choosing an antidepressant for a medically ill patient is a common clinical problem. There is an increased prevalence of depression among patients with many medical illnesses. The clinician must be familiar with the recent additions to the antidepressant armamentarium, including the synaptic pharmacology and pharmacokinetics of the available agents. The factors usually used to guide antidepressant selection must be augmented by a careful evaluation of the patient's medical illness and therapeutic regimen. Special attention must be paid to the potenhal for drug-illness and drug-drug interactions. The author has used the example of four illnesses commonly associated with depression-stroke, cancer, Parkinson's disease, and dementia-to illustrate how these considerations affect the choice of an antidepressant