scholarly journals Patient adherence in the treatment of depression

2002 ◽  
Vol 180 (2) ◽  
pp. 104-109 ◽  
Author(s):  
S. Pampallona ◽  
P. Bollini ◽  
G. Tibaldi ◽  
B. Kupelnick ◽  
C. Munizza
Keyword(s):  
Response Rate ◽  
Patient Adherence ◽  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Unipolar Depression ◽  
Quantitative Evidence ◽  
Quantitative Studies ◽  
Treatment Of Depression ◽  
Review Criteria ◽  
Combined Interventions

BackgroundNon-adherence with antidepressant treatment is very common. Increasing adherence to pharmacological treatment may affect response rate.AimsTo review and summarise quantitative evidence on factors associated with adherence and of adherence-enhancing interventions.MethodA systematic review of computerised databases was carried out to identify quantitative studies of adherence in depression. Papers retained addressed unipolar depression and considered adherence as the primary end-point.ResultsOf studies published between 1973 and 1999, 32 met the review criteria: epidemiological descriptive studies (n=14): non-random comparisons of control and intervention groups (n=3); randomised interventions (n=14); and meta-analysis (n=1). Patient education and medication clinics were the interventions most commonly tested, combined with a variety of other interventions.ConclusionsThe studies did not give consistent indications of which interventions may be effective. Carefully designed clinical trials are needed to clarify the effect of single and combined interventions.

scholarly journals Clinical trials of antidepressant medications are producing meaningless results

2003 ◽  
Vol 183 (2) ◽  
pp. 102-104 ◽  
Author(s):  
Gordon Parker ◽  
Ian M. Anderson ◽  
Peter Haddad
Keyword(s):  
Clinical Trials ◽  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Antidepressant Medication ◽  
Unipolar Depression ◽  
Controlled Trials ◽  
Antidepressant Medications ◽  
Treatment Of Depression ◽  
Randomised Controlled ◽  
The Uk

A recent alert from the UK Committee on Safety of Medicines stated that the dangers of treatment of depression with paroxetine outweigh the benefits in those under 18. Such a warning should focus our minds on the evidence on which clinical practice is based. Antidepressant treatment of depression in the under-18s has been thought to be justified because clinical trials show that it works so well in over-18s. But is that a reasonable assessment of the evidence? Kirsch et al (2002) use the analogy of ‘The Emperor's New Clothes' to describe the findings from their meta-analysis of randomised placebo-controlled trials of antidepressants. They conclude that antidepressant medication appears to have only a small effect on outcome over and above placebo. In this analogy psychiatry is the emperor, drug trials are the fraudsters and the deception is being revealed by a growing body of critical opinion proposing that, once methodological problems with clinical trials are taken into account, antidepressants either do not work at all or have an effect that is so small as to be clinically unimportant (Andrews, 2001; Moncrieff, 2002). A large number of randomised placebo-controlled trials of antidepressants have been carried out over the past decades, mostly funded by the pharmaceutical industry, and it is now recognised that about 50% of negative trials go unpublished (Thase, 1999). Meanwhile, unipolar depression has jumped into the top five of the world's total burden of disease, and there is an imperative need for effective and safe treatments. Do we need more randomised controlled trials (RCTs) of antidepressant medications, or has that research paradigm outlived its usefulness? In this month's debate, Professor Gordon Parker, University of New South Wales and Black Dog Institute, Australia, and Drs Ian Anderson and Peter Haddad from the University of Manchester discuss whether clinical trials for antidepressant medication produce meaningless results.

Recent Developments in Geriatric Psychopharmacotherapy

1994 ◽  
Vol 39 (8_suppl) ◽  
pp. 9-18 ◽  
Author(s):  
Alastair J. Flint
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Bipolar Affective Disorder ◽  
Unipolar Depression ◽  
The Elderly ◽  
Blood Levels ◽  
Pharmacological Management ◽  
Treatment Of Depression ◽  
Recent Developments ◽  
Psychiatric Complications

This paper highlights recent advances in the pharmacological management of geriatric affective disorders and dementia. The current roles of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) in the treatment of depression in old age are discussed. Recent findings pertaining to continuation and maintenance of antidepressant treatment are also addressed. The treatment of bipolar affective disorder in the elderly has received much less study than has unipolar depression. A number of issues relating to efficacy, side-effects and optimal blood levels of lithium, carbamazepine and valproate in bipolar disorder remain unresolved and await further study. Finally, drug treatment of the cognitive impairment and psychiatric complications of Alzheimer's disease is reviewed.

scholarly journals Overview of antidepressant treatment of bipolar depression

2013 ◽  
Vol 16 (7) ◽  
pp. 1673-1685 ◽  
Author(s):  
Gustavo H. Vázquez ◽  
Leonardo Tondo ◽  
Juan Undurraga ◽  
Ross J. Baldessarini
Keyword(s):  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Unipolar Depression ◽  
Placebo Treatment ◽  
Research Literature ◽  
Therapeutic Trials ◽  
Significant Disability ◽  
Short And Long Term

Abstract Bipolar depression remains a major unresolved challenge for psychiatric therapeutics. It is associated with significant disability and mortality and represents the major proportion of the approximately half of follow-up time spent in morbid states despite use of available treatments. Evidence regarding effectiveness of standard treatments, particularly with antidepressants, remains limited and inconsistent. We reviewed available clinical and research literature concerning treatment with antidepressants in bipolar depression and its comparison with unipolar depression. Research evidence concerning efficacy and safety of commonly used antidepressant treatments for acute bipolar depression is very limited. Nevertheless, an updated meta-analysis indicated that overall efficacy was significantly greater with antidepressants than with placebo-treatment and not less than was found in trials for unipolar major depression. Moreover, risks of non-spontaneous mood-switching specifically associated with antidepressant treatment are less than appears to be widely believed. The findings encourage additional efforts to test antidepressants adequately in bipolar depression, and to consider options for depression in types I vs. II bipolar disorder, depression with subsyndromal hypomania and optimal treatment of mixed agitated-dysphoric states – both short- and long-term. Many therapeutic trials considered were small, varied in design, often involved co-treatments, or lacked adequate controls.

scholarly journals Treatment of depression in schizophrenia: Systematic review and meta-analysis

2017 ◽  
Vol 211 (4) ◽  
pp. 198-204 ◽  
Author(s):  
Angharad Gregory ◽  
Pavan Mallikarjun ◽  
Rachel Upthegrove
Keyword(s):  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Significant Risk ◽  
Depression Score ◽  
Risk Difference ◽  
Mean Difference ◽  
Number Needed To Treat ◽  
Inclusion Criteria ◽  
Treatment Of Depression ◽  
Meta Analyses

BackgroundDepression in schizophrenia predicts poor outcomes, including suicide, yet the effectiveness of antidepressants for its treatment remains uncertain.AimsTo synthesise the evidence of the effectiveness of antidepressants for the treatment of depression in schizophrenia.MethodMultiple databases Were searched and inclusion Criteria included participants aged over 18 years with schizophrenia or related psychosis with a depressive episode. Papers were quality assessed used the Cochrane risk bias tool. Meta-analyses were performed for risk difference and standardised mean difference of all antidepressants, antidepressant class and individual antidepressant where sufficient studies allowed.ResultsA total of 26 moderate- to low-quality trials met inclusion criteria. In meta-analysis a significant risk difference was found in favour of antidepressant treatment, with a number needed to treat of 5 (95% CI 4–9). Studies using tools specifically designed to assess depression in schizophrenia showed a larger effect size. However, after sensitivity analysis standardised mean difference of all antidepressants did not show a statistically significant improvement in depression score at end-point, neither did any individual antidepressant class.ConclusionsAntidepressants may be effective for the treatment of depression in schizophrenia, however, the evidence is mixed and conclusions must be qualified by the small number of low- or moderate-quality studies. Further sufficiently powered, high-quality studies are needed.

Antidepressants for the treatment of depression in people with schizophrenia: a systematic review

2003 ◽  
Vol 33 (4) ◽  
pp. 589-599 ◽  
Author(s):  
C. WHITEHEAD ◽  
S. MOSS ◽  
A. CARDNO ◽  
G. LEWIS
Keyword(s):  
Rating Scale ◽  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Antidepressant Medication ◽  
Clinical Effectiveness ◽  
Cochrane Library ◽  
Psychotic Symptoms ◽  
Stable Phase ◽  
Treatment Of Depression ◽  
Increased Risk

Background. Depression is common in people with schizophrenia and is associated with substantial morbidity and an increased risk of suicide. Our aim was to review systematically all the randomized controlled trials that have investigated the clinical effectiveness of antidepressant medication in the treatment of depression in people who also suffer with schizophrenia.Method. Electronic searches of ClinPsych, the Cochrane Library, the Cochrane Schizophrenia Group's Register of Trials, EMBASE and Medline were completed. Reference lists from identified articles were hand searched.Results. Eleven small studies were identified and all randomized fewer than 30 subjects to each group. We could only perform analyses on a subset of the trials. For five trials (aggregate N=209) the proportion improved in the antidepressant group was 26% (95% CI 10% to 42%) higher than in the placebo group. In six studies (aggregate N=267) the standardized mean difference on the Hamilton Rating Scale for Depression at the end of the trial was −0·27 (95% CI −0·7 to 0·2). There was no evidence that antidepressant treatment given during the stable phase of illness led to a deterioration of psychotic symptoms in the included trials.Conclusions. The literature reviewed was, overall, of poor quality and only a small number of trials could contribute towards the meta-analysis. The results provide weak evidence for the effectiveness of antidepressants in those with schizophrenia and depression and could be explained by publication bias. We need further research to determine the best approach towards treating depression in people with schizophrenia.

Diagnosis, assessment, and treatment of depression in advanced disease

2018 ◽  
Author(s):  
Matthew Hotopf
Keyword(s):  
Palliative Care ◽  
Advanced Disease ◽  
Antidepressant Treatment ◽  
Population Level ◽  
Care Staff ◽  
Care Services ◽  
Treatment Of Depression ◽  
Assessment And Treatment ◽  
Palliative Care Services ◽  
Key Issues

Depression in palliative care is common, under-recognised and has significant impacts for sufferers. There are effective treatments but often a shortage of staff to provide them. This chapter sets out a number of key issues to consider when assessing and treating individual patients and considers the way in which palliative care services can innovate to provide a population level response to depression. Palliative care staff can be trained to deliver basic depression care and follow simple protocols to initiate, monitor and adjust antidepressant treatment. These approaches have been tested in trials in cancer care but the challenge is to take these approaches from research trials conducted in centres of excellence with good resources, to other settings.

scholarly journals Stepped care for the treatment of depression: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Amado Rivero-Santana ◽  
Lilisbeth Perestelo-Perez ◽  
Yolanda Alvarez-Perez ◽  
Vanesa Ramos-Garcia ◽  
Andrea Duarte-Díaz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Stepped Care ◽  
Treatment Of Depression
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