NOTE: Non-responding patients should be switched to an alternative 1st choice agent prior to attempting a 2nd choice antidepressant.

1. Usual daily doses are provided unless otherwise stated. Consult the drug monograph for details on age and condition specific dosing.
2. Approximate costs were derived from the ODB formulary (#36) or manufacturers' price lists and do not include professional fees or markups.
3. "Natural" medicines, particularly St. John's Wort (SJW), have become popular as an alternative for the treatment of depression. SJW is prepared from the extract of Hypericum Perforatum L. The word "Wort" is old English for plant. The plant is commonly called St. John's Wort because it flowers around June 24th held to be the birth date of St. John the Baptist. Several studies have been done showing the efficacy of SJW compared to placebo for the treatment of mild to moderate depression although diagnostic criteria remain unclear. Comparative studies show similar efficacy and better tolerability against amitriptyline, imipramine, and maprotiline, and studies with SSRIs are underway. SJW appears to be well tolerated, with an absence of anticholinergic, sedative and addictive properties. At the recommended dose, there is no MAO inhibitor action. SJW appears to block the reuptake or serotonin, norepinephrine and dopamine into the pre-synaptic cell. Futher aeidence is required before SJW can be considered as a standard antidepressant therapy.
4.May have fewere anticholinergic side effects than other TCAs.
5.Food and drug restrictions apply. Two-week washout required after discontinuation.
6. Comorbidity of depression and anziety states occur 3 times more frequently than would be expected by chance. The strongest association is between panic disorder and depresssion.

From: CANMAT - Guidelines for the Diagnosis and Pharmacological Treatment of Depression (1st Edition Rev., 1999) Page 18.

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Back to Managing Depressive Disorders - (Selections from: CANMAT - Guidelines for the Diagnosis and Pharmacological Treatment of Depression (1st Edition Rev., 1999)