Signposts in the treatment of depression and anxiety. Different effects of various medications in the treatment of depression, anxiety and insomnia – in the example of escitalopram, duloxetine, mianserin, pregabalin and quetiapine

The paper presents clinical examples of the treatment of depressive and anxiety disorders from the author’s own practice. The first part presents the concept of pairing of the specific drug action profile to the profile of indivi­dual patient needs and the concept of “drug-centered psychopharmacology”. When choosing a medication for the treatment of depression and/or anxiety, one should take into account the individual characteristics of the patient regarding his personality, values, reasons for seeking treatment, expectations towards the therapy and expected further life goals. They range widely from the characteristics of certain biologically conditioned dimensions, such as novelty seeking, the level of aggressiveness, neuroticism or extraversion – to the dimension including the system of values and beliefs. Individual patient’s features and the context of the situation in which she/he is presenting her/his symptoms is important in the context of the choice of personalized treatment. With regard to a drug, one should take into account the individual characteristics of a given drug as a substance with a specific effect on physiological and pathophysiological processes. This understanding of the individual characteristics of drug action goes beyond the more traditional concepts, limited to the provisions that it is an antidepressant and/or anxiolytic drug. We already have more detailed knowledge related to specific dimensions of psycho-biological action, describing the influence of substances classified in a given group of drugs on the mental and physical processes. In the second part, based on the case reports of patients treated with escitalopram, duloxetine, pregabalin, mianserin and quetiapine clinical vignettes are outlined in which the use of these drugs was beneficial in the subjective perception of patients, while in an objective assessment it led to the relief of depressive symptoms.