The treatment of severe depression : is there an efficacy gap between SSRI and TCA antidepressant generations ? Discussion

Background: Depression is classified along a spectrum of severity that may have implications for treatment. Since the newer generation of serotonin selective reuptake inhibitors (SSRIs) has, for the most part, displaced the older tricyclic antidepressants (TCAs) as first-line treatment, the efficacy of the SSRIs compared with the TCAs for severe depressions has been questioned. Method: I reviewed all available English-language literature in the MEDLINE data base that compared the SSRIs with the TCAs, especially those studies on severe depression. Results: Most of the studies that explored the efficacy of the SSRIs, as compared with the TCAs, for severe depression found that these two classes of antidepressants were equivalent. Nevertheless, only a few studies actually studied severely depressed inpatients