What are the recommended first-line pharmacological treatments for depression in adults?

For adults with depression who wish to start antidepressant treatment, the recommended first-line pharmacological options are selective serotonin reuptake inhibitors (SSRIs) or serotonin noradrenaline reuptake inhibitors (SNRIs) ¹. These are recommended due to their tolerability and safety profile ¹. A tricyclic antidepressant (TCA) may be preferred if the individual has responded well to it in the past and there are no contraindications ¹. For people presenting with chronic depressive symptoms who have not received previous treatment for depression, SSRIs, SNRIs, or TCAs are also considered treatment options ³. It is important to note that St John's wort is not recommended for depression due to uncertainties regarding appropriate doses, persistence of effect, variation in preparations, and potential serious interactions with other drugs ¹,⁴. The choice of treatment should always be a shared decision, based on the person's clinical needs and preferences ³.