Chasing Quality - Clinical Practice Guidelines and HEDIS Measures of Asthma and Depression Therapy Management

Utilization and Drug Cost Outcomes of a Step-Therapy Edit for Generic Antidepressants in an HMO in an Integrated Health System

“…27 In the ARTIST (A Randomized Trial Investigating SSRI Treatment) study, 46% of patients (n = 256) with major depressive disorder treated with an SSRI were nonresponders at 6 months, and 53% of the patients (n = 222) who received SSRI therapy for at least 6 months did not achieve remission. 28 While a minimum of 6 to 8 weeks of antidepressant drug therapy is considered to be necessary to determine if antidepressant drug therapy will be effective, 29 30% to 50% of patients have substantial residual symptoms after adequate first-line therapy, 30 and the absence of improvement after 4 weeks of treatment with an adequate dose of a given antidepressant predicts an ultimate inadequate response.…”

Switching Antidepressant Drug Therapy Helps Some Patients Some of the Time--What TORDIA, STAR*D, and Observational Research Have Taught Us About Treatment-Resistant Depression

“…As Curtiss observed previously in JMCP, (a) antidepressant drug therapy alone is not much more effective than placebo, and the difference between antidepressant drug and placebo varies among clinical trials, with the effect of the active drug larger in patients with more severe depression, and (b) drug therapy is about as effective as psychotherapy, generally described as cognitive behavioral therapy (CBT). 3,4 In a meta-analysis of data from 7 randomized controlled trials of the selective serotonin reuptake inhibitors (SSRIs), bupropion, or placebo, Thase et al found that after 6-8 weeks of follow-up, 51% of outpatients with moderate to severe recurrent major depres sive disorder (MDD) responded (i.e., demonstrated a ≥ 50% reduction in Hamilton Rating Scale for Depression [HAM-D] scores) to placebo as compared with 62%-63% for pharma cotherapy. Remission (i.e., a score of 7 or less on the first 17 HAM-D items) was experienced by 36% of the patients who received placebo and 47% who received pharmacotherapy.…”