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]
I find this site always full of the latest information and trends.
Thanks Roz, I’m pleased that you’re finding the website useful.
I see that the latest stats on antidepressant usage in the US are being reported:
Eleven percent of Americans aged 12 years and over take antidepressant medication.
Females are more likely to take antidepressants than are males, and non-Hispanic white persons are more likely to take antidepressants than are non-Hispanic black and Mexican-American persons.
About one-third of persons with severe depressive symptoms take antidepressant medication.
More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
Less than one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year.
Pratt LA, Brody DJ, Gu Q. Antidepressant use in persons aged 12 and over: United States, 2005–2008. NCHS data brief, no 76. Hyattsville, MD: National Center for Health Statistics. 2011.
The Mental Elf
I remain very sceptical of modern psychiatry and the ability of psychiatrists to make any difference to their patients. Their principal strategy seems to be treatment of the symptoms rather than the person with a succession of different drugs in the vague hope that one of them might work! Some of these drugs do as much harm as good and can be very difficult to stop due to nasty withdrawal symptoms. What most patients want is hope, because they can see nothing hopeful from their depressed perspective, but they are more likely to get this from friends, family, their local priest or a professional who has the time and understanding to talk to them, not from someone who just pushes pills.