To develop a profile of the ideal antidepressant compound based on a pharmacologic model. The current perspectives on depression and anxiety and the entity of mixed anxiety depression are reviewed. Depression and anxiety manifestations are differentiated but they strongly overlap. We review special perspectives viewed along the frameworks of somatic and psychic anxiety, and cognitive and vegetative features of depression. Specialized groups such as addicts, medically ill and geriatric patients, have their own particular problems - relevant aspects are examined in the pharmacologic context.
Special subdivisions lead to a more fruitful approach as to the patient s pharmacologic needs.
Legitimate approaches are examined. The numerous antidepressant compounds are evaluated for side-effect profile with emphasis on serotonin excess symptoms. Serotonin modulates many basic functions at a large number of levels allowing explanations of why its influences are so diverse. The numerous serotonin receptor subtypes and specificity is critical to appreciating why drugs work and fail and why such paradoxic reactions as anxiety or anti-anxiety effects may occur with the same drug in different patients. Three clinical scenarios relate to patients who fail treatment after receiving selective serotonin re-uptake inhibitor drugs.