1. The diagnosis of major depression requires:

· a dysphoric mood or decreased interest in usual activities and
· at least four additional classic depressive signs and symptoms,
· which must be sustained for at least 2 weeks,
· cannot be explained by another process known to cause depressive symptoms.

2. Most patients with major depression do best with a combination of antidepressant medications and some form of psychotherapy.

3. A useful criterion for antidepressant treatment is evidence of impaired function in their work role or relationships.

4. More formal psychotherapies such as cognitive-behavioural therapy (CBT), may be considered as first-line treatment in patients with mild to moderate first onset major depression.

5. Virtually all available antidepressants are equally effective if given at an adequate dose for a sufficient period of time (3).

6. Selective serotonin reuptake inhibitors (SSRIs) have become the first-line treatment for depression. The principle rationale includes their safety in overdose and generally good tolerability.

7. Patients with major depression who are started on antidepressants should be seen weekly during the initial 6 to 8 weeks of pharmacotherapy.

8. A delay in the onset of antidepressant response of at least 1 to 2 weeks occurs with all antidepressants.

9. In those who do respond, full recovery may take up to 6 weeks or longer. It is recommended that response to antidepressants should be evaluated between 4 and 6 weeks.  A 25% or greater reduction in baseline symptom severity should serve as a reasonable criterion for extending the initial treatment.

10. Antidepressants should be continued for at least 6 months, and up to 12 months, after a single episode of major depression, as there is a high risk of relapse in this period (1).

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