An international group of eminent clinicians have produced an executive report for the World Psychiatric Association, which looks at how well antidepressants work in the acute treatment of depression.
The study is described as a ‘scholarly narrative review’ and the authors have considered guidelines, systematic reviews, meta-analyses and randomised controlled trials from a very wide range of sources.
An executive summary is available for free, but you have to pay to read the full article, which covers a number of key areas:
- Are antidepressants effective in the treatment of depressive disorders in RCTs and in effectiveness studies designed to represent more routine practice?
- Which measures, including the comparison of means, the number needed to treat (NNT) or meta-analyses, are the best to evaluate their beneficial use?
- Is there evidence for differences in the efficacy and effectiveness of antidepressants with different pharmacodynamic properties and in comparison with psychosocial therapies?
- Is there evidence for differences in effectiveness in different severity or clinical subtypes of depressive syndromes?
- The review considered the prediction of antidepressant efficacy, the use of treatment algorithms, and the importance of considering and preventing suicidal behaviour during antidepressant treatments.
The authors conclude:
Modern strategies for the clinical management of depression, which include pharmacotherapy, should consider structured treatment plans and algorithm-guided treatments, especially in cases of primary treatment failures. Psychotherapies with sufficient evidence for efficacy in the treatment of depression should also be considered along with psychosocial support and providing healthy lifestyle information to the patient and any caregivers. This is simply good clinical practice.
Baghai TC, Blier P, Baldwin DS, Bauer M, Goodwin GM, Fountoulakis KN, Kasper S, Leonard BE, Malt UF, Stein DJ, Versiani M, Möller HJ. Executive summary of the report by the WPA section on pharmacopsychiatry on general and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders (PDF). Eur Arch Psychiatry Clin Neurosci. 2011 Nov 15. [Epub ahead of print]