3-3.4. Choice of antidepressant The

3-3.4. Choice of antidepressant
The Cochrane review we conducted showed that antidepres- sants are more effective than placebo in treating depressed patients with physical illness, including those with life- threatening physical illness Though there is no evidence that any particular antidepressant is preferable for palliative patients, a recent meta-analysis in physically well people indicated that some second generation antidepressants are marginally more effective and better tolerated than others. We recommend, therefore, that clinicians become familiar with two or three of the better performing antidepressants (e.g. mirtazapine, sertraline and citalopram). Tricyclic antide- pressants pose greater risk in overdose than SSRIs and are of ten contraindicated in palliative care patients due to heart disease, liver failure or prostatic hypertrophy. However, ami triptyline and other tricyclic antidepressants are potential second-line medicines, which may be useful for patients with neuropathic pain.92 Given the lack of evidence for a clearly superior antidepressant, choice of drug should be based on the type of comorbid physical illness, the patient's symptom profile, potential side-effects, interactions and contraindica tions, clinician familiarity and patient preference