The management of depression: the evidence speaks for itself (original) (raw)
Related papers
Journal of Psychopharmacology, 2008
A revision of the 2000 British Association for Psychopharmacology evidencebased guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.
Journal of Psychopharmacology, 2000
A revision of the 2000 British Association for Psychopharmacology evidencebased guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.
2024
Health, as defined by the World Health Organization, encompasses complete mental, physical, and social well-being. Despite this, mental health issues are prevalent in the UK, with depression being notably pervasive. This paper reviews the historical and current approaches to treating depression, highlighting a significant reliance on pharmacological interventions. Historical data shows that treatments have evolved from confining patients in asylums to using antidepressants, which became prominent in the 1950s. These medications, while beneficial for symptom management, have led to dependency issues due to their side effects and the body's tolerance development. Current statistics indicate a substantial increase in antidepressant prescriptions, which some attribute to overdiagnosis rather than advancements in understanding depression. The treatment spectrum for depression includes various antidepressants like Selective serotonin reuptake inhibitors (SSRIs) and Serotonin-norepinephrine reuptake inhibitors (SNRIs), with prescriptions often extended without thorough evaluation of long-term effectiveness or patient well-being. This practice has raised concerns about the over-medicalisation of depression, overshadowing alternative therapies such as cognitive behavioural therapy (CBT), which may offer sustainable benefits without the drawbacks of medication. Given the complex interplay of biological, psychological, and social factors in depression, this paper argues for a more integrated treatment approach. It suggests prioritising personalised care and broadening treatment modalities to better address the multifaceted nature of mental health issues.
Clinical practice recommendations for depression
Acta Psychiatrica Scandinavica, 2009
Objective: To provide clinically relevant evidence-based recommendations for the management of depression in adults that are informative, easy to assimilate and facilitate clinical decision making. Method: A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. The recommendations then underwent consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. Results: The clinical practice recommendations for depression (Depression CPR) summarize evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. Conclusion: These up-to-date recommendations provide an evidencebased framework that incorporates clinical wisdom and consideration of individual factors in the management of depression. Further, the novel style and practical approach should promote uptake and implementation.
A Systematic Review of Comparative Efficacy of Treatments and Controls for Depression
PLoS ONE, 2012
Background: Although previous meta-analyses have examined effects of antidepressants, psychotherapy, and alternative therapies for depression, the efficacy of these treatments alone and in combination has not been systematically compared. We hypothesized that the differences between approved depression treatments and controls would be small. Methods and Findings: The authors first reviewed data from Food and Drug Administration Summary Basis of Approval reports of 62 pivotal antidepressant trials consisting of data from 13,802 depressed patients. This was followed by a systematic review of data from 115 published trials evaluating efficacy of psychotherapies and alternative therapies for depression. The published depression trials consisted of 10,310 depressed patients. We assessed the percentage symptom reduction experienced by the patients based on treatment assignment. Overall, antidepressants led to greater symptom reduction compared to placebo among both unpublished FDA data and published trials (F = 38.5, df = 239, p,0.001). In the published trials we noted that the magnitude of symptom reduction with active depression treatments compared to controls was significantly larger when raters evaluating treatment effects were un-blinded compared to the trials with blinded raters (F = 2.17, df = 313, p,0.05). In the blinded trials, the combination of antidepressants and psychotherapy provided a slight advantage over antidepressants (p = 0.027) and psychotherapy (p = 0.022) alone. The magnitude of symptom reduction was greater with psychotherapies compared to placebo (p = 0.019), treatment-as-usual (p = 0.012) and waiting-list (p,0.001). Differences were not seen with psychotherapy compared to antidepressants, alternative therapies or active intervention controls. Conclusions: In conclusion, the combination of psychotherapy and antidepressants for depression may provide a slight advantage whereas antidepressants alone and psychotherapy alone are not significantly different from alternative therapies or active intervention controls. These data suggest that type of treatment offered is less important than getting depressed patients involved in an active therapeutic program. Future research should consider whether certain patient profiles might justify a specific treatment modality.
Depression: current approaches to management in primary care
Prescriber, 2009
Our Drug review describes current prescribing guidelines and the properties of the antidepressant drugs available and discusses recent controversies surrounding antidepressant use. This is followed by further sources of information in Resources and an analysis of prescription data.
Drug treatment of depression: reflections on the evidence
Advances in Psychiatric Treatment, 2003
Guidelines are readily available for the treatment of depression, and more recent ones are explicitly evidence-based. Their core messages vary little but they tend to minimise uncertainties and gloss over difficult areas. This article examines three areas of uncertainty: the thresholds of severity and, for milder depression, the duration of illness for which antidepressants are more effective than placebo; the next step in drug treatment when a patient has failed to respond adequately to a first antidepressant; and how long continuing on antidepressants should be recommended in relation to individual patients' needs. It is concluded that the uncertainties in relation to treating individual patients are a combination of lack of evidence and individual patient factors but there is also an intrinsic uncertainty that will continue to require good clinical judgement.
Psychiatria i Psychologia Kliniczna, 2018
The high prevalence of depression globally and the severe burden of this life-threatening mental illness necessitate an evidence-based approach to its treatment, in order to offer best-possible relief to those suffering from it. The present bestpractice guideline was originally developed by a team of psychiatrists, psychologists, and other mental health professionals at a large psychiatric teaching hospital and outpatient clinic network in Michigan, USA. The document draws from several current major guidelines for the treatment of adult patients with depressive disorders published by national and international health organisations, such as the American Psychiatric Association (USA), Canadian Network for Mood and Anxiety Treatments (Canada), National Institute for Health and Care Excellence (UK) and World Health Organization (EU). The present document emphasizes the areas of broad consensus across these guidelines and, as such, the treatment recommendations contained herein represent the current "gold standard" in the field of psychiatry in the West. Part I of this two-part series covers a range of relevant psychiatric treatment aspects, from general patient management to treatment-stagespecific and population-specific recommendations. Special attention is given to pharmacotherapy, somatic therapies, treatment strategies for non-response and management of perinatal depression. Additional resources, including clinicianand patient-oriented websites and links to the full-text major published guidelines, where available, are provided. Psychiatric clinicians are encouraged to utilise the evidence-based practice recommendations for best-possible patient outcomes.