[Biological treatment strategies of depression--psychopharmacology and non-pharmacological methods]

Biological treatment procedures are based on evidence-based guidelines. According to all of them, a correct diagnosis of depression is required before starting therapy. Within recent years many different types of antidepressants have been introduced to the pharmacotherapeutic armamentarium. The "newer" antidepressants were developed with a view to reduced side effects. However, the classes of antidepressants currently available differ little in their antidepressant efficacy, thus, all producing treatment responses of 50 - 75 %. Therefore, the selection of a particular antidepressant for the individual patient depends on various factors: patient's prior experience with medication, concurrent medical conditions that may be worsened by selected antidepressants, concomitant use of non-psychiatric medications that may lead to negative drug-drug interactions, a drug's short and long-term side effects, physician's experience with the medication and patient's history of adherence to medication. Importantly, if the patient does not show any improvement after two to four weeks of treatment with an antidepressant dose at the upper level of the standard dose, it becomes less likely that he will respond to this particular medication later. When a partial or non-response is present, several therapeutic options are available: (1) combining two antidepressants from different classes, (2) switch to new antidepressant from a different or the same pharmacological class and (3) augmentation strategies. For patients who are reluctant to take traditional antidepressants, herbal remedies such as hypericum perforatum (St. John's Wort) provide an alternative for treatment of mild to moderate depression. Besides pharmacological treatment options non pharmacological biological interventions are available. Electroconvulsive therapy and partial sleep deprivation are very effective in the treatment of acute depression. Especially for seasonal affective disorders light therapy is a well established treatment alternative. Further new biological treatment approaches such as rapid transcranial magnetic stimulation (rTMS) showed inconsistent results.