Depressive Disorders in Primary Care: A Review

Gilbody, Simon; Gask, Linda

doi:10.1002/9780470745892.ch6

Cited by 3 publications

(1 citation statement)

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“…In many places around the world, depression is mainly managed in primary care settings where the prevalence of depressive disorders has been estimated to range from 10 to 20%. 1,2 Despite this, much of the evidence for the effectiveness of drug treatments used for depression have been based on studies conducted on patients treated in secondary and tertiary settings. Observational studies have found the naturalistic course of depressive disorders encountered in primary care tends to be less severe VOLUME 8 • NUMBER 4 • DECEMBER 2016 J OURNAL OF PRIMARY HEALTH CARE and less complicated than those seen in specialist settings, with many primary care patients going into remission without treatment.…”

Section: Introductionmentioning

confidence: 99%

Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis

et al. 2016

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INTRODUCTION Evidence for the effectiveness of drug treatment for depression in primary care settings remains limited, with little information on newer antidepressant classes. AIM To update an earlier Cochrane review on the effectiveness of antidepressants in primary care to include newer antidepressant classes, and to examine the efficacy of individual agents. METHODS Selection criteria included antidepressant studies with a randomly assigned placebo group where half or more subjects were recruited from primary care. The Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) group searched multiple databases to identify eligible studies. Data extraction was performed independently by two reviewers. Data were analysed using Revman version 5.3.5. RESULTS In total, 17 papers and 22 comparisons were included for analysis. Significant benefits in terms of response were found for tricyclic antidepressants (TCA) with a relative risk (RR) = 1.23 (95% CI, 1.01-1.48), and serotonin selective reuptake inhibitors (SSRI) with a RR = 1.33 (95% CI, 1.20-1.48). Mianserin was effective for continuous outcomes. Numbers needed to treat (NNT) for TCA = 8.5; SSRI = 6.5; and venlafaxine = 6. Most studies were industry-funded and of a brief duration (≤ 8 weeks). There was evidence of publication bias. There were no studies comparing newer antidepressants against placebo. CONCLUSION Antidepressants such as TCA, SSRI, SNRI (serotonin-norepinephrine reuptake inhibitor) and NaSSA (noradrenergic and specific serotonergic antidepressant) classes appear to be effective in primary care when compared with placebo. However, in view of the potential for publication bias and that only four studies were not funded by industry, caution is needed when considering their use in primary care.

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Section: Introductionmentioning

confidence: 99%

Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis

et al. 2016

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Better care through an optimized mental health services continuum (Eastern Townships, Québec, Canada): A systematic and multisource literature review

Roy

Dagenais

Pinsonneault

et al. 2018

Health Planning & Management

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SummaryIntroductionIn 2014, the health authorities of the Eastern Townships (Québec, Canada) commissioned an evaluation of the mental health admission system for adults (GASMA) to identify the best GASMA organizational or structural elements and optimize the mental health services continuum.MethodsTo develop better services, seven indicators (ie, accessibility to services, integration of levels of services, user satisfaction, guidance and management time, evaluation tools, professional composition, and interprofessional collaboration) were examined through four evaluation questions. A three‐step systematic and multisource evaluation was realized. A systematic review of the scientific and gray literature was performed. This evaluation also included key informant opinions to contextualize results from this review.ResultsResults from 91 scientific articles, 40 gray literature documents, and 10 interviews highlighted determinants and barriers associated with the examined indicators. From these results, 24 preliminary recommendations were formulated and discussed in a steering committee. These recommendations were then weighted and validated. This served to formulate three final recommendations.ConclusionTo optimize the regional mental health services continuum, stakeholders should (1) implement a single‐window access for adults with mental health needs, (2) develop alternative services based on users' needs, and (3) test the effectiveness of new methods, initiatives, and tools.

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Drug Repurposing in CNS and Clinical Trials: Recent Achievements and Perspectives Focusing on Epilepsy and Related Comorbidities

Machado Parreira,

Pinheiro de Oliveira,

Oliveira Guarnieri

et al. 2024

Frontiers in Clinical Drug Research - CNS and Neurological Disorders

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Central Nervous System (CNS) disorders are a massive burden on the global health system, including a broad range of clinical conditions, such as epilepsies, depression, dementia, multiple sclerosis, and Parkinson’s disease. Permanent efforts are being made to find early, non-invasive, and effective diagnostic methods, as well as efficient and safe drug-based treatments for CNS conditions. Nevertheless, many patients displaying these clinical conditions still face the lack of an effective pharmacotherapy to cure the diseases or at least to properly control the progression of symptoms. Currently, epilepsies present an estimated prevalence of 0.5%–1% worldwide, and around 30% of the patients remain refractory to the available drug treatment. The comorbidities that affect epileptic patients, such as cognitive impairment and depression, are major public health challenges. This scenario highlights the urgent need for approving new therapeutic tools for CNS diseases. A successful development process of a new compound presenting therapeutic potential can range up to 20 years and cost hundreds of millions of US dollars, from the initial characterization of the in vitro chemical and biological properties until clinical trials. Additionally, drug development has a low success rate in the case of CNS conditions. In this context, drug repurposing (or drug repositioning, DR) is an alternative way to reduce the cost and accelerate the process of a drug-based treatment approach since it identifies a novel clinical application for an existing compound already approved for a distinct indication. In the present chapter, we aim to describe recent outcomes of DR aiming at CNS pathological conditions, especially discussing the recent clinical trials and their impacts on future endeavors in the search for the management of epilepsies and related comorbidities.

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Depressive Disorders in Primary Care: A Review

Cited by 3 publications

References 142 publications

Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis

Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis

Better care through an optimized mental health services continuum (Eastern Townships, Québec, Canada): A systematic and multisource literature review

Drug Repurposing in CNS and Clinical Trials: Recent Achievements and Perspectives Focusing on Epilepsy and Related Comorbidities

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