Recent advances in the management of depression and psychopharmacology.
OBJECTIVE: To review the recent advances in the management of depression and psychopharmacology. DATA SOURCES: Medline and non-Medline literature search. STUDY SELECTION: The following key words were used: depression/therapy, depressive disorders, antidepressant, psychopharmacology, and mental health services. Years of study: 1988 to 1998. DATA EXTRACTION: Original articles, review papers, meta-analyses, and relevant book chapters were reviewed. DATA SYNTHESIS: Recent advances in research on depression have confirmed that it is a common, recurrent, and disabling medical disorder. The latest epidemiological studies from the United States suggest that its lifetime prevalence is more than 17%, while a lower, but still substantial, proportion of Chinese people have the same disorder. The highly recurrent nature and conspicuous morbidity of depression call for the continuation of antidepressant treatment beyond the initial resolution of symptoms. For the first episode of depression, 6 to 9 months of adequate antidepressant treatment is indicated. For patients with recurrent depression, maintenance therapy for several years is needed. The increasingly widespread use of selective serotonin re-uptake inhibitors and other newer antidepressants has increased the direct drug cost, but the total health care expenditure may not be raised and may even be reduced. CONCLUSION: Proper recognition and management of depression at both the clinical and health care policy levels are urgently needed.