Ranking antidepressants

Seyringer, Michaela-Elena; Kasper, Siegfried

doi:10.1016/s0140-6736(09)60976-4

Cited by 12 publications

(5 citation statements)

References 2 publications

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“…The meta-analysis concluded that sertraline may be the best first-line treatment for moderate to severe major depression, considering its efficacy, acceptability, and cost. However, this recommendation was not without controversy, with some researchers pointing out that there may have been methodologic issues (e.g., failure to account for potential confounders such as psychiatric comorbidity, starting dose, titration schedule, or concomitant benzodiazepine use) or publication bias (Seyringer & Kasper, 2009). There is no one-size-fits-all treatment for MDD, making broad recommendations such as these challenging.…”

Section: Major Depression and Persistent Depressive Disordermentioning

confidence: 99%

Pharmacological treatment of depressive disorders.

Hantsoo¹,

Mathews²

2019

APA Handbook of Psychopharmacology.

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Section: Major Depression and Persistent Depressive Disordermentioning

confidence: 99%

Pharmacological treatment of depressive disorders.

Hantsoo¹,

Mathews²

2019

APA Handbook of Psychopharmacology.

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“…One objection is that efficacy is in fact already by itself a hybrid of true efficacy and tolerability because of the last observation carried forward (LOCF) method. Many authors argue that the results and conclusions are not in accord with clinical experience, probably because the data set is incomplete and there is a great heterogeneity between the included randomized controlled trials (RCTs) (Seyringer and Kasper, 2009; Turner et al, 2009). On the contrary Gartlehner et al (2008) concluded that there are no solid data in support of a true difference between agents.…”

Section: Most Significant Meta-analytic Studies On Major Depressionmentioning

confidence: 99%

Burning issues in the meta-analysis of pharmaceutical trials for depression

2013

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During the last decade a number of meta-analytic studies have been published and they triggered a debate on the true clinical usefulness of antidepressants. The current article comments on problems within the randomized controlled trials design, the study samples, the psychometric scales, the methods of meta-analysis, the interpretation of the results, and the reporting of conflicts of interest. Although the meta-analyses published so far agree that medication works in severe depression, they question its efficacy in mild cases. However, several methodological issues should be clarified before conclusions are definite. Different methods give different results and similar results seem to entertain a variety of interpretations. In the future it is important to address all of these problems, and to improve methodology on the basis of clinically informed choices. Otherwise, meta-analysis risks alienation from clinical reality and thus risks becoming the 21(st) century psychoanalysis.

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“…Based on a comparison of 12 new-generation antidepressants, the authors came to the conclusion that, considering both efficacy and non-discontinuation (as proxy for tolerability) escitalopram is the most preferable drug, followed by sertraline. However, this metaanalysis did not include placebo-controlled studies, which makes the generalisability, together with other methodological problems, somewhat questionable [167].…”

Section: The Efficacy Of Antidepressants Is Well Proven and They Are mentioning

confidence: 99%

Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression

et al. 2012

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This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5-7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of 'the right drug/treatment for the right patient' is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.

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Ranking antidepressants

Cited by 12 publications

References 2 publications

Pharmacological treatment of depressive disorders.

Pharmacological treatment of depressive disorders.

Burning issues in the meta-analysis of pharmaceutical trials for depression

Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression

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