A practical approach to the management of depression.

Depression is a common and treatable condition. Failure to diagnose it may lead to unnecessary investigations, delay in treatment and an increased risk of suicide. Anti-depressant drugs are the first line of treatment. Tricyclics are generally the drugs of choice as their efficacy is very well established. Second generation antidepressant drugs are preferred for the elderly and those with heart disease as they tend to have milder side effects and are less toxic in overdose. Electroconvulsive therapy is indicated in those with severe depression, high suicide risk or failed drug treatment. Psychotherapy is usually used as an adjunct to pharmacotherapy whilst lithium is used to prevent recurrence of depression.