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According to the World Health Organization (WHO), depression is defined as a common mental disorder with symptoms of depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, decreased sleep or appetite, and poor concentration. Beginning with the discovery of monoamine oxidase inhibitors (MOAIs), tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are also developed as therapeutic measures for depression. However, management of depression is still challenging to clinicians as many adverse effects are found with these agents and some questions are still unanswered, creating a few lacunae to research. So to fulfill those lacunae, drugs, namely agomelatine, vortioxetine, vilazodone, and levomilnacipran extended release (ER) having different mechanisms have been recently approved by the United States Food and Drug Administration (FDA). Agomelatine helps in the normalization of disturbed circadian rhythm by melatonergic agonist action. Vortioxetine is a serotonin transporter (SERT) blocker with additional actions such as 5HT3 and 5HT7 receptors blockade. It is also an agonist of 5HT1A and a partial agonist of 5HT1B receptors. It is the first drug in the antidepressant class approved by FDA which has such multimodal actions. Vilazodone is approved by FDA considering its early onset of antidepressant actions. Levomilnacipran ER is an enantiomer of milnacipran, approved recently by FDA for the treatment of major depressive disorder (MDD). This review helps the clinician to choose better drugs according to patient's clinical needs. Significant efforts must be taken for conducting clinical trials assessing the efficacy of combination of drugs having different mechanisms such as agomelatine and vilazodone. [ABSTRACT FROM AUTHOR]

Context: Prescribing is a challenging task requiring knowledge of essential medicine (EM), rational use of medicines (RUM) and personal drugs (P-drug). Though the majority of clinicians recognize the importance of RUM, most of them have not been able to apply this knowledge in their medical practice. Aims: The aim of the following study is to assess knowledge, attitude and practice of clinicians about RUM, EM, P-drugs, and sources of drug information. Settings and Design: A cross-sectional, questionnaire based study. Subjects and Methods: Study was carried out in 100 respondents including faculty members and junior residents (JRs) in a tertiary-care teaching hospital. Statistical Analysis: Univariate analysis was carried out using fisher's exact test. Results: Nearly 93% respondents were aware about EM, but only 79% prescribe them. Percentage is significantly higher in respondents of age more than 30, having clinical experience <5 years and in faculty members as compared to residents. Nearly 87% respondents were aware about RUM, but only 83 % practice it. Though 30 % respondents practiced P-drug concept only 1% were aware about STEP criteria. Practicing P-drug concept was significantly more in JRs compared to faculty members (P < 0.0001). None of the respondents were aware about the number of drugs in National List of EMs of India. Conclusions: It is an encouraging finding that higher percentages of clinicians were aware about EM and also prescribed it. However, level of understanding related to P-drug concept and existence of essential medicines list are much below par. Also prescribing by trade name and heavy dependency on medical representatives for drug information is the matter of concern. [ABSTRACT FROM AUTHOR]