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While in the past the almost sole availability of tricyclic antidepressants had limited antidepressant drug selection, newer drugs such as selective serotonin reuptake inhibitors, bupropion, mirtazapine and venlafaxine have vastly simplified treating depression in patients with medical illness. Appropriate selection of an antidepressant agent in medically ill patients requires a careful risk-benefit assessment of the antidepressant treatment considering the pharmacokinetic and pharmacodynamic properties of drugs, potential for drug interaction, the patient’s general medical conditions, and primary symptoms of the patient’s depression. The effective and safe approach to antidepressant treatment is to reduce initial dosage, to titrate upward more slowly, and to monitor closely adverse effects in patients with medical illness.
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