What is the first-line treatment for Major Depressive Disorder according to current guidelines?

The first-line treatment for Major Depressive Disorder (MDD), according to current guidelines, is Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are favored due to their favorable side effect profile, relatively high efficacy, and safety in overdose compared to other classes of antidepressants. They work by increasing serotonin levels in the brain, which can help improve mood and alleviate depressive symptoms.

SSRIs have become the standard treatment option because they are generally well-tolerated and have a lower risk of adverse effects compared to tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). While TCAs can be effective, they often cause more side effects, such as dry mouth, constipation, and sedation. MAOIs, while effective as well, require dietary restrictions and monitoring for hypertensive crises, making them less convenient for patients.

Bupropion, though effective for some patients, particularly for those with significant fatigue or anhedonia, is often considered after SSRIs or in conjunction with them, as it has distinct mechanisms of action and addition to treatment protocols. Thus, the recommendation to use SSRIs as a first-line treatment stems from a balance of effectiveness, safety, and tolerability