Editorial note

As depression has been identified as the fourth leading cause of disease burden, accounting for 12% of total disability worldwide (Üstün et al., 2004), and because drug treatment is one of the most widely used, this chapter is a very important one. There are several messages that need to be disseminated from this chapter. Firstly, antidepressant drugs, despite many improvements over the years, remain drugs with many adverse effects, and selection of a drug is likely to be determined more by its adverse effect profile than by its efficacy rating. Next, depression is often combined with other disorders, and treatment must take into account the nature of these other conditions and the effect of drug treatment upon them. A third message is very important to clinicians; do not increase the dose of an antidepressant too readily. Response, particularly the full response, to an antidepressant is often delayed, and rushing to a high dose will only add to adverse effects at a time when the patient is not well prepared to deal with them. The treatment of bipolar disorder is associated with more controversy than depression alone, especially in the maintenance phase, and here there is a difference between recommendations in the United States and those of other countries, with much greater use of a typical antipsychotics and sodium valproate in the USA and more emphasis on lithium elsewhere, with bigger differences in the maintenance than acute phases of treatment.