Antidepressants: Complete Guide to Depression Medication
📊 Quick facts about antidepressants
💡 The most important things you need to know
- SSRI medications are usually the first choice: They have fewer side effects than older antidepressants and are equally effective for most people
- Patience is essential: Antidepressants take 2-4 weeks to begin working and 6-8 weeks for full effect
- Never stop suddenly: Always taper off medication gradually under medical supervision to avoid withdrawal symptoms
- Side effects often improve: Initial side effects like nausea and headache typically diminish within the first few weeks
- Continue treatment after feeling better: Treatment should continue for at least 6 months after symptoms improve to prevent relapse
- Different medications work for different people: If one antidepressant doesn't work, another type may be more effective
How Do Antidepressants Work?
Antidepressants work by affecting neurotransmitters in the brain, particularly serotonin, norepinephrine, and dopamine. These chemical messengers play crucial roles in regulating mood, emotions, and overall mental well-being. By increasing the availability of these neurotransmitters, antidepressants help restore the chemical balance that may be disrupted in depression.
Understanding how antidepressants work begins with understanding the brain's communication system. Neurons (nerve cells) in the brain communicate with each other through chemical messengers called neurotransmitters. When one neuron releases a neurotransmitter, it crosses a small gap called the synapse and binds to receptors on the receiving neuron, transmitting a signal. After the signal is sent, the neurotransmitter is typically reabsorbed by the sending neuron in a process called reuptake.
Depression has been linked to imbalances in certain neurotransmitters, particularly serotonin and norepinephrine. While the exact relationship between neurotransmitter levels and mood is complex and not fully understood, research has consistently shown that medications affecting these chemicals can effectively treat depression symptoms in many people.
Different types of antidepressants work through different mechanisms, but most share a common goal: increasing the availability of mood-regulating neurotransmitters in the brain. This doesn't happen immediately, which is why antidepressants take time to work. The brain needs to adapt to the changes in neurotransmitter levels, and this process of neuroplasticity and receptor adjustment takes several weeks.
The Role of Serotonin
Serotonin is often called the "feel-good" neurotransmitter because of its role in regulating mood, sleep, appetite, and overall sense of well-being. Low levels of serotonin have been associated with depression, anxiety, and other mood disorders. Most modern antidepressants, particularly SSRIs, work primarily by blocking the reuptake of serotonin, allowing more of this neurotransmitter to remain available in the synaptic gap between neurons.
Norepinephrine and Dopamine
Norepinephrine affects alertness, energy, and the body's stress response. Dopamine is involved in motivation, pleasure, and reward pathways. Some antidepressants, particularly SNRIs and certain atypical antidepressants, target these neurotransmitters in addition to or instead of serotonin. This can be particularly helpful for people who experience depression symptoms related to energy, motivation, and concentration.
While antidepressants begin affecting neurotransmitter levels immediately, the therapeutic benefits take weeks to appear. This delay occurs because the brain needs time to adjust to the new chemical environment. Receptors must adapt, new neural connections form, and the overall brain chemistry needs to stabilize. This is why it's crucial to continue taking medication as prescribed even if you don't feel immediate improvement.
What Are the Different Types of Antidepressants?
The main types of antidepressants include SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors), TCAs (tricyclic antidepressants), and atypical antidepressants. SSRIs are typically prescribed first due to their effectiveness and favorable side effect profile. Different medications may work better for different individuals.
Antidepressant medications have evolved significantly since the first drugs were discovered in the 1950s. Today, doctors have multiple options to choose from, each with its own mechanism of action, benefits, and potential side effects. Understanding these different classes can help you have more informed conversations with your healthcare provider about your treatment options.
The choice of antidepressant depends on various factors including the severity of depression, specific symptoms, previous treatment responses, potential drug interactions, side effect profiles, and individual patient preferences. What works well for one person may not be the best choice for another, which is why finding the right medication sometimes requires trying different options.
SSRIs (Selective Serotonin Reuptake Inhibitors)
SSRIs are the most commonly prescribed antidepressants worldwide and are typically the first-line treatment for depression. They work by blocking the reuptake of serotonin in the brain, increasing its availability. SSRIs are preferred as initial treatment because they generally have fewer side effects than older antidepressants and are safer in overdose situations.
Common SSRI medications include:
- Sertraline (Zoloft) - Often used for depression and anxiety disorders
- Fluoxetine (Prozac) - One of the oldest SSRIs, approved for children with depression
- Escitalopram (Lexapro) - Known for good tolerability
- Citalopram (Celexa) - Similar to escitalopram
- Paroxetine (Paxil) - Also effective for anxiety disorders
- Fluvoxamine (Luvox) - Often used for OCD
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
SNRIs work on both serotonin and norepinephrine, potentially providing additional benefits for people who don't respond well to SSRIs alone. They may be particularly helpful for depression accompanied by chronic pain, fatigue, or difficulty concentrating. The dual action on two neurotransmitter systems can provide broader symptom relief for some patients.
Common SNRI medications include:
- Venlafaxine (Effexor) - Available in extended-release form
- Duloxetine (Cymbalta) - Also approved for chronic pain conditions
TCAs (Tricyclic Antidepressants)
Tricyclic antidepressants are an older class of medications that affect multiple neurotransmitter systems, including serotonin and norepinephrine. While effective, they typically cause more side effects than newer medications and can be dangerous in overdose. TCAs are usually reserved for cases where newer medications haven't been effective or for specific conditions like chronic pain.
The name "tricyclic" refers to the chemical structure of these medications, which contains three interconnected rings of atoms. Because TCAs affect multiple receptor systems beyond just the target neurotransmitters, they tend to cause more side effects including dry mouth, constipation, urinary retention, and drowsiness.
Common TCA medications include:
- Amitriptyline - Also used for chronic pain and migraine prevention
- Nortriptyline - Generally better tolerated than other TCAs
- Clomipramine - Often used for OCD
Atypical Antidepressants
This category includes medications that don't fit neatly into other categories and work through various mechanisms. They may be used when other antidepressants haven't been effective or when specific symptoms need to be targeted. Each atypical antidepressant has a unique profile that may make it particularly suitable for certain patients.
Examples include:
- Bupropion (Wellbutrin) - Works on dopamine and norepinephrine; doesn't cause sexual side effects or weight gain
- Mirtazapine (Remeron) - Can help with sleep and appetite; may cause drowsiness and weight gain
- Vortioxetine (Trintellix) - Newer medication with multimodal action
- Agomelatine - Works on melatonin receptors; may help with sleep
| Type | Primary Mechanism | Common Side Effects | When Used |
|---|---|---|---|
| SSRI | Blocks serotonin reuptake | Nausea, sexual dysfunction, insomnia | First-line treatment for most patients |
| SNRI | Blocks serotonin and norepinephrine reuptake | Similar to SSRI plus sweating, increased blood pressure | When SSRI fails; depression with pain |
| TCA | Multiple neurotransmitter effects | Dry mouth, constipation, drowsiness, weight gain | Severe depression; treatment-resistant cases |
| Atypical | Varies by medication | Varies by medication | Specific symptom profiles; when others fail |
What Should I Expect When Starting Antidepressants?
When starting antidepressants, expect a gradual improvement over 2-8 weeks rather than immediate relief. Initial side effects like nausea, headache, and sleep changes are common but usually improve within the first few weeks. Your doctor will start with a low dose and gradually increase it to minimize side effects and find the optimal therapeutic dose.
Beginning treatment with antidepressants requires patience and realistic expectations. Unlike pain medications that work within hours, antidepressants need time to produce their therapeutic effects. Understanding this timeline helps prevent discouragement and premature discontinuation of treatment.
Most healthcare providers start with a low dose and gradually increase it over several weeks. This approach, called titration, helps your body adjust to the medication and minimizes the intensity of initial side effects. The target dose depends on the specific medication, your symptoms, and how you respond to treatment.
During the first few weeks, you may actually feel worse before you feel better. Some people experience increased anxiety or agitation, particularly with SSRIs. This is usually temporary and resolves as your brain adjusts to the medication. However, it's important to stay in contact with your healthcare provider during this period, especially if symptoms become severe or include thoughts of self-harm.
Timeline of Improvement
The timeline for experiencing benefits from antidepressants varies between individuals, but a general pattern exists:
- Week 1-2: Side effects most prominent; minimal therapeutic effect
- Week 2-4: Side effects begin to decrease; subtle improvements in sleep, energy, or appetite may appear
- Week 4-6: More noticeable improvement in mood; side effects continue to diminish
- Week 6-8: Full therapeutic effect typically achieved; medication can be properly evaluated
Initial Side Effects
Common side effects when starting antidepressants include nausea, headaches, dizziness, drowsiness or insomnia, dry mouth, and digestive issues. Most of these effects are mild and temporary, resolving within the first few weeks as your body adjusts. Taking medication with food, staying well hydrated, and taking doses at optimal times (morning for energizing medications, evening for sedating ones) can help manage these effects.
Young adults (under 25) and anyone starting or changing antidepressant doses should be monitored closely for worsening depression, unusual behavior changes, or suicidal thoughts, particularly during the first few weeks. Contact your healthcare provider immediately if you experience significant mood changes or concerning thoughts.
What Are the Common Side Effects of Antidepressants?
Common side effects of antidepressants include nausea, headache, dry mouth, drowsiness, insomnia, sexual dysfunction, weight changes, and digestive issues. Most side effects are mild and improve within 1-2 weeks. Different classes of antidepressants have different side effect profiles, and switching medications may help if side effects are problematic.
Side effects are a concern for many people considering antidepressant treatment. While no medication is completely free of side effects, understanding what to expect and how to manage them can make treatment more manageable. It's important to remember that not everyone experiences all side effects, and many side effects diminish or disappear entirely with continued use.
The type and severity of side effects depend on the specific medication, the dose, and individual factors. Some people are more sensitive to certain medications than others. If side effects are bothersome, your doctor can adjust the dose, change the timing of doses, or switch to a different medication with a more favorable side effect profile for you.
Gastrointestinal Side Effects
Nausea, diarrhea, and stomach upset are among the most common side effects, particularly with SSRIs and SNRIs. These typically occur in the first few days to weeks of treatment and usually resolve as your body adjusts. Taking medication with food can often help reduce stomach upset. In some cases, starting with a lower dose and gradually increasing can minimize these effects.
Sleep Changes
Antidepressants can affect sleep in different ways depending on the medication. Some cause drowsiness and are best taken at bedtime, while others may cause insomnia and should be taken in the morning. Vivid dreams or nightmares are also reported by some patients. Your doctor can help you find the optimal timing for your medication based on how it affects your sleep.
Sexual Side Effects
Sexual dysfunction is a common concern with many antidepressants, particularly SSRIs. Effects may include decreased libido, difficulty achieving orgasm, and erectile dysfunction. These side effects often persist throughout treatment but may improve at lower doses. Bupropion and mirtazapine are less likely to cause sexual side effects and may be alternatives for people significantly affected by this issue.
Weight Changes
Some antidepressants can cause weight gain, while others are weight-neutral or may even lead to weight loss. Mirtazapine and some TCAs are more likely to cause weight gain, while bupropion may help with weight management. If weight changes are a concern, discuss medication options with your healthcare provider.
Dry Mouth and Other Anticholinergic Effects
Dry mouth, constipation, urinary retention, and blurred vision are more common with TCAs but can occur with other antidepressants as well. Staying hydrated, using sugar-free gum or candy, and maintaining good oral hygiene can help manage dry mouth. Increasing fiber and water intake can help with constipation.
While most side effects are manageable, contact your healthcare provider if you experience severe nausea or vomiting, significant mood changes or increased anxiety, thoughts of self-harm, allergic reactions (rash, swelling, difficulty breathing), or side effects that significantly impact your daily life. Never stop taking your medication abruptly without medical guidance.
How Long Will I Need to Take Antidepressants?
Treatment duration varies but typically includes at least 6-12 months of medication after symptoms improve to prevent relapse. Some people may need longer treatment, especially if they've had multiple depressive episodes. The decision to continue or stop medication should always be made with your healthcare provider based on your individual situation.
The question of treatment duration is important and highly individual. While antidepressants can effectively control depression symptoms, the underlying vulnerability to depression often remains. This is why treatment typically continues well beyond the point when you start feeling better.
Research shows that stopping antidepressants too early significantly increases the risk of relapse. Studies indicate that continuing medication for at least 6-12 months after symptoms have resolved reduces the risk of depression returning. For people who have had multiple episodes of depression, longer-term or even lifelong treatment may be recommended.
The decision about when and whether to stop medication depends on many factors: the severity of your depression, how many episodes you've had, how well you've responded to treatment, your personal preferences, and your life circumstances. Some people take antidepressants for a defined period and successfully discontinue, while others benefit from ongoing treatment.
Factors Affecting Treatment Duration
Several factors influence how long you might need antidepressant treatment:
- Number of previous episodes: People with recurrent depression often benefit from longer treatment
- Severity of episodes: More severe depression may require longer treatment to prevent relapse
- Residual symptoms: If symptoms haven't fully resolved, continuing treatment is usually recommended
- Life stressors: Ongoing stress may warrant continued medication support
- Family history: Strong family history of depression may suggest need for longer treatment
- Response to treatment: Excellent response may allow for eventual discontinuation; partial response may require ongoing treatment
Maintenance Treatment
For people with recurrent or chronic depression, maintenance treatment means continuing medication indefinitely to prevent future episodes. This approach is similar to how people with other chronic conditions like diabetes or high blood pressure take medication long-term. The goal is not just to treat current symptoms but to prevent future episodes and their associated disruption to life.
What Happens When I Stop Taking Antidepressants?
Stopping antidepressants abruptly can cause discontinuation syndrome with symptoms like dizziness, nausea, anxiety, and flu-like feelings. To avoid this, medications should be tapered gradually over weeks to months under medical supervision. Never stop taking antidepressants suddenly without consulting your healthcare provider.
When the time comes to stop antidepressant treatment, the process needs to be managed carefully. Discontinuation syndrome, sometimes called antidepressant withdrawal, can occur when medication is stopped too quickly. This isn't addiction in the traditional sense, but rather reflects the brain's adaptation to the medication over time.
The brain adjusts its neurotransmitter systems in response to antidepressant medication. When medication is stopped suddenly, it takes time for the brain to readjust. Gradual tapering gives the brain time to adapt, minimizing uncomfortable symptoms and reducing the risk of depression relapse.
Discontinuation symptoms typically begin within a few days of stopping or significantly reducing the dose and may last from one to several weeks. Symptoms can include dizziness or vertigo, nausea, fatigue, headaches, sleep disturbances, irritability, anxiety, and sensations sometimes described as "brain zaps" (brief electrical shock-like sensations in the head).
The Tapering Process
A typical tapering schedule involves gradually reducing the dose over several weeks to months, depending on the medication and how long you've been taking it. Your doctor will create a specific plan based on your situation. Generally, the longer you've been on medication and the higher your dose, the more gradual the taper should be.
Some medications are easier to taper than others. Fluoxetine (Prozac), for example, has a long half-life and is often easier to discontinue. Paroxetine (Paxil) and venlafaxine (Effexor) have shorter half-lives and may require more careful tapering.
Monitoring for Relapse
During and after discontinuation, it's important to monitor for signs that depression may be returning. This is different from discontinuation symptoms. Discontinuation symptoms typically appear within days and resolve within weeks. Depression relapse usually develops more gradually, over weeks to months, and symptoms persist and worsen rather than improving.
Stopping antidepressants suddenly can cause uncomfortable withdrawal symptoms and significantly increases the risk of depression relapse. Always work with your healthcare provider to create a gradual tapering plan. If you're having trouble affording or accessing your medication, contact your provider for help rather than stopping on your own.
Are Antidepressants Safe During Pregnancy and Breastfeeding?
Some antidepressants can be used during pregnancy and breastfeeding, but the decision requires careful consideration of risks and benefits with your healthcare provider. Untreated depression during pregnancy also carries risks for both mother and baby. Certain SSRIs are considered relatively safe, but each situation must be evaluated individually.
The question of antidepressant use during pregnancy and breastfeeding involves balancing multiple considerations. Depression itself poses risks during pregnancy, including potential impacts on prenatal care, nutrition, and bonding with the baby. Untreated maternal depression has been associated with preterm birth, low birth weight, and potential developmental effects on children.
At the same time, all medications carry some degree of risk during pregnancy. The key is to weigh these risks against the risks of untreated depression. For many women with moderate to severe depression, the benefits of continued treatment outweigh the potential risks of medication.
If you're pregnant or planning to become pregnant, don't stop your antidepressant medication without consulting your healthcare provider. Sudden discontinuation can lead to depression relapse, which may be more harmful than continuing medication. Your doctor can help you make an informed decision about whether to continue, adjust, or change your medication.
Pregnancy Considerations
Certain SSRIs, particularly sertraline (Zoloft) and citalopram (Celexa), have more safety data during pregnancy than others. However, no antidepressant is completely without risk. Potential concerns include a small increased risk of certain birth defects (though absolute risk remains low), potential for neonatal adaptation syndrome (temporary symptoms in newborns exposed to SSRIs), and possible effects on the developing brain, though research in this area is ongoing and inconclusive.
Breastfeeding Considerations
Most antidepressants pass into breast milk in small amounts. Sertraline and paroxetine tend to have lower levels in breast milk compared to other SSRIs. For most women, the benefits of breastfeeding while taking antidepressants outweigh the potential risks. The risk to the infant from medication exposure through breast milk is generally considered very low.
If you're pregnant or planning pregnancy and taking antidepressants, schedule a consultation with your healthcare provider as soon as possible. Don't discontinue medication on your own. A shared decision-making approach, considering your depression history, severity, and treatment options, will help determine the best path forward for both you and your baby.
Can Children and Teenagers Take Antidepressants?
Antidepressants can be prescribed for children and adolescents with depression, but with careful monitoring. Fluoxetine (Prozac) is specifically approved for pediatric depression from age 8. Close monitoring is essential because young people may be more susceptible to certain side effects, including increased suicidal thoughts in some cases.
Depression affects children and teenagers as well as adults, and antidepressant medication can be an important part of treatment. However, the approach to treating young people differs in several important ways from adult treatment. The developing brain may respond differently to medications, and close monitoring is essential throughout treatment.
For mild to moderate depression in young people, psychotherapy is often recommended as the first-line treatment. Cognitive-behavioral therapy (CBT) and interpersonal therapy have shown effectiveness in pediatric depression. Medication is typically considered when depression is severe, doesn't respond to therapy alone, or when symptoms significantly impair functioning.
The FDA has issued a "black box" warning for antidepressants in children and young adults (under 25), noting an increased risk of suicidal thoughts and behaviors, particularly during the first few weeks of treatment or when doses are changed. This doesn't mean antidepressants shouldn't be used in young people, but it emphasizes the importance of careful monitoring.
Medications Approved for Pediatric Use
Fluoxetine (Prozac) is the only antidepressant specifically FDA-approved for treating depression in children (ages 8 and older). However, other medications are sometimes prescribed "off-label" when clinically appropriate. Escitalopram is approved for adolescents aged 12 and older with depression.
Parental Involvement
Parents and caregivers play a crucial role in treatment. Before starting medication, ensure a trusted adult can supervise medication administration, monitor for side effects and mood changes, communicate regularly with the treatment team, and help the young person attend appointments and therapy sessions.
During the initial treatment phase and any time doses are changed, close monitoring for mood changes, increased anxiety, agitation, or any concerning behaviors is essential. Any signs of worsening symptoms or suicidal thoughts should be reported to the healthcare provider immediately.
Can I Drink Alcohol While Taking Antidepressants?
Alcohol can worsen depression symptoms and increase side effects from antidepressants, including drowsiness and impaired judgment. While moderate occasional alcohol use may be acceptable with some medications, it's best to discuss your specific situation with your doctor. Some combinations can be particularly dangerous.
The relationship between alcohol and antidepressants is complicated. Alcohol itself is a depressant that can worsen depression symptoms and interfere with recovery. Even aside from medication interactions, reducing or eliminating alcohol consumption is generally recommended for people with depression.
From a pharmacological standpoint, alcohol can enhance the sedating effects of many antidepressants, potentially causing excessive drowsiness, impaired coordination, and slowed reaction times. This can be dangerous, particularly when driving or operating machinery. Alcohol can also affect how your body metabolizes medication, potentially reducing effectiveness or increasing side effects.
The risks vary depending on the specific medication. MAOIs (an older class of antidepressants rarely used today) have particularly dangerous interactions with certain alcoholic beverages containing tyramine, which can cause dangerous spikes in blood pressure. TCAs combined with alcohol can cause significant drowsiness and impairment. Even with SSRIs and SNRIs, which have fewer direct interactions, alcohol can still interfere with treatment.
Practical Recommendations
If you choose to drink while taking antidepressants, consider limiting yourself to occasional, moderate amounts. Avoid drinking during the initial adjustment period when side effects are most prominent. Never drive or engage in activities requiring alertness after drinking. Be aware that your tolerance may be lower than before starting medication.
Beyond medication interactions, alcohol use can significantly undermine depression treatment. Alcohol can worsen depression symptoms, interfere with sleep quality, reduce motivation for self-care and therapy, and increase impulsive behaviors. If you find it difficult to limit or stop alcohol use, discuss this with your healthcare provider, as this may need to be addressed as part of your overall treatment plan.
What Other Medications Can Interact with Antidepressants?
Antidepressants can interact with many other medications, including other psychiatric medications, pain relievers, blood thinners, and some herbal supplements. Serotonin syndrome is a rare but serious risk when combining multiple serotonergic medications. Always inform your healthcare provider about all medications and supplements you take.
Drug interactions are an important consideration with antidepressant treatment. Because antidepressants affect neurotransmitter systems and are processed by specific liver enzymes, they can interact with a wide range of other substances. Some interactions can reduce medication effectiveness, while others can cause dangerous side effects.
One of the most serious potential interactions involves the risk of serotonin syndrome, a condition caused by excessive serotonin activity in the nervous system. This can occur when combining SSRIs or SNRIs with other medications that increase serotonin levels, including certain pain medications (tramadol, fentanyl), migraine medications (triptans), other antidepressants, certain supplements (St. John's Wort, SAMe), and some anti-nausea medications.
Symptoms of serotonin syndrome range from mild (shivering, diarrhea) to severe (high fever, seizures, irregular heartbeat). Severe cases require immediate medical attention. The risk increases with higher doses and when multiple serotonergic substances are combined.
Common Medication Interactions
Important interactions to be aware of include:
- Blood thinners (warfarin): SSRIs can increase bleeding risk when combined with anticoagulants
- NSAIDs (ibuprofen, aspirin): Increased risk of gastrointestinal bleeding when combined with SSRIs
- Benzodiazepines: Enhanced sedation when combined with sedating antidepressants
- Thyroid medications: TCAs may affect thyroid hormone metabolism
- Diabetes medications: Some antidepressants can affect blood sugar control
Herbal Supplements
Natural doesn't mean safe when it comes to interactions. St. John's Wort is a particular concern because it has serotonergic effects and can cause serotonin syndrome when combined with antidepressants. It can also accelerate the breakdown of many medications, reducing their effectiveness. Other supplements that may interact include SAMe, 5-HTP, and ginkgo biloba.
Maintain an up-to-date list of all medications you take, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements. Share this list with every healthcare provider you see, including dentists and specialists. When starting any new medication or supplement, check with your pharmacist or doctor about potential interactions.
Frequently Asked Questions About Antidepressants
Medical References and Sources
This article is based on current medical research and international guidelines. All claims are supported by scientific evidence from peer-reviewed sources.
- American Psychiatric Association (2023). "Practice Guideline for the Treatment of Patients with Major Depressive Disorder." APA Guidelines Clinical practice guidelines for depression treatment. Evidence level: 1A
- National Institute for Health and Care Excellence (NICE) (2022). "Depression in adults: treatment and management." NG222. NICE Guidelines UK guidelines for depression management in adults.
- Cipriani A, et al. (2018). "Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis." The Lancet. 391(10128):1357-1366. DOI: 10.1016/S0140-6736(17)32802-7 Landmark network meta-analysis comparing antidepressant effectiveness.
- World Health Organization (2023). "Depression Fact Sheet." WHO Depression Information Global perspectives on depression treatment and management.
- Gabriel M, Sharma V (2017). "Antidepressant discontinuation syndrome." Canadian Medical Association Journal. 189(21):E747. Review of discontinuation symptoms and management strategies.
- Malhi GS, et al. (2021). "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: major depression summary." The Medical Journal of Australia. 215(S7):S3-S13. Evidence-based guidelines for depression treatment.
Evidence grading: This article uses the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation) for evidence-based medicine. Evidence level 1A represents the highest quality of evidence, based on systematic reviews of randomized controlled trials.
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