Stressful external conditions may significantly increase disposition to depression in persons with higher risk for development of depression. The hereditary background affects strongly stress tolerance and is characterised by considerable inter-person differences. The clinical variability of depression proceeds from the interaction between different genotypes and different environmental impacts. It has been proved experimentally that the response of different persons to the action of one and the same neuroactive substance is also dependent on their social status.
There exist no antidepressants equally effective for all forms of depression. Each depression patient requires an antidepressant whose neurochemical type of action ensures maximum efficiency for him or her. To prescribe the most suitable individual drug for a patient, the physician should have the opportunity as well as the ability to select the most appropriate drug from among a large number of antidepressants.
The aims of depression treatment are the following:
1. To achieve remission as effectively and quickly as possible, to eliminate all symptoms of depression – emotional, cognitive, behavioural and somatic. In the acute phase, usually multiaction antidepressants and evidence based polypragmasia are preferred, while also use of benzodiasepins and sedatives is necessary. Long-term treatment of depression using a depressant with the same type of action is poorly justified. Depending on the change in the clinical picture of depression, also the action profile of the drug should be changed. There are no good or poor antidepressants but there are failed prescriptions.
2. To restore pre-disease professional capacity, psychosocial coping and quality of life.
3. To minimise the likelihood of depression recurrence.