Solving the problem of antidepressant selection in Lithuania.

PURPOSE To ascertain the opinion of psychiatrists of the factors those determine antidepressants selection. MATERIAL AND METHODS An original questionnaire of 30 questions, which deals with reliance of antidepressants selection according to the subtype of depression, was represented for a quarter of all Lithuanian psychiatrists. RESULTS Respondents for depression with obsession 36% chose paroxetine. It is interesting that despite the controversial opinion about the TCAprescribing according to their side effects profile and safety to use, our respondent chose amitriptyline for the melancholic depression with suicidal thoughts (50.2%) and for the anesthetic depression (28%). In some cases there is no unanimous opinion among the psychiatrists--data scattering was received in selection, the respondents chose different antidepressants from different groups in similar frequency. For the treatment of the adynamic depression--7.6%--amitriptyline, 12.1%--citalopram, 10.6%--reboxetine, 10.6%--venlafaxine, for the anxious depression--15.2%--amitriptyline, about 20%--citalopram, 15.2%--mirtazapin, for the anesthetic depression 14.3%--escitalopram, 9%--sertraline, 8.3%--venlafaxine. There is no clear tendency or prevailing antidepressant. CONCLUSIONS Psychopathological peculiarity of depression can be one of the most important criteria in antidepressant selection. However, in many cases, the subtype of depression is ascertained empirically and based solely on the personal experience and clinical practice of the psychiatrist. There are no clear diagnostic criteria or practical guidelines for the reliable verification of the psychopathological subtype of depression, which would allow for the selection of a more adequate and prompt treatment for the patient.