What is considered the first-line treatment for major depression?

The first-line treatment for major depressive disorder is typically guided by evidence supporting the efficacy, tolerability, and side effect profiles of various pharmacological options. Selective serotonin reuptake inhibitors (SSRIs) have become the preferred initial therapeutic choice for several reasons.

SSRIs, which include medications like fluoxetine, sertraline, and escitalopram, specifically target serotonin pathways in the brain, leading to improvements in mood and emotional regulation. They are generally well-tolerated, have a favorable side effect profile compared to older antidepressants, and have shown significant efficacy in treating depression symptoms. Their relatively wide safety margin also makes them suitable for use in a broader patient population, including those with co-existing medical conditions.

In contrast, other classes of antidepressants such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are effective but are reserved for cases where SSRIs are ineffective or not tolerated. TCAs have a higher incidence of side effects, including potential cardiotoxicity and anticholinergic effects, while MAOIs require dietary restrictions to avoid hypertensive crises, making them less practical as first-line options. Electroconvulsive therapy (ECT) is typically considered in severe cases or when rapid