The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared

Lawrenson, R; Tyrer, Freya; Newson, R B; Farmer, Richard

doi:10.1016/s0165-0327(99)00147-0

Cited by 136 publications

(86 citation statements)

References 15 publications

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“…8 Unfortunately, we are constrained to this period because we do not have data on TCA sales prior to 1988 for the United States. A similar pattern seems to hold for the U.K.: Between 1991 and 1996, prescriptions of older tricyclic antidepressants (TCAs) increased by 40 percent, while those for SSRIs increased by 460 percent (Lawrenson et al, 2000). 9 Thanks to an anonymous referee for this observation.…”

Section: Discussionmentioning

confidence: 70%

“…2 For example, in a recent trial, SSRIs were found to nearly double the number of depression-free days compared to placebo (Mallick et al, 2003). While other medications have also been shown to reduce depression, compared to other anti-depressants, the SSRIs are less toxic in overdose and have fewer side effects and so may be prescribed more often and taken for longer durations (Guze, 1996;Lawrenson et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

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Anti-depressants, suicide, and drug regulation

Ludwig

Marcotte

2005

J. Pol. Anal. Manage.

131

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Anti-depressants, suicide, and drug regulation

Ludwig

Marcotte

2005

J. Pol. Anal. Manage.

131

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“…Side effects of antidepressant drugs have strong consequences on prescription behaviour, adherence and discontinuation of drug use. While SSRIs and TCAs are similarly effective [33], SSRIs are prescribed more often because of their favourable side-effect profile [34]. Rates of antidepressant treatment discontinuation can reach up to 60 per cent, and adverse effects are the most common reason for nonadherence and drug discontinuation [35].…”

Section: Nocebo Effects In Antidepressant Trialsmentioning

confidence: 99%

Lessons learned from placebo groups in antidepressant trials

Shedden-Mora

Nestoriuc

Rief

2011

Phil. Trans. R. Soc. B

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This comprehensive review provides an overview about placebo and nocebo phenomena in antidepressant trials. Improvements in the placebo groups may partly be explained through methodological issues such as natural course of depression and regression to the mean, but also fundamentally reflect investigators' and participants' expectations. A meta-analysis by our group of 96 randomized placebo-controlled trials showed large placebo responses to antidepressant medication. Moderator analyses revealed substantially larger placebo responses in observer ratings compared with self-report. Effect sizes in observer ratings showed strong increase with publication year while this effect was not found for patients' self-ratings. This reflects the strong influence of investigators' expectations. The analysis of 'nocebo effects', e.g. adverse effects in placebo groups of antidepressant trials also confirms the impact of expectations: nocebo symptoms reflected the typical side-effect patterns expected in the drug group, with higher symptoms rates in the placebo groups of tricyclic antidepressant trials compared with placebo groups of trials testing selective serotonin reuptake inhibitors. While the placebo response seems to be similar for women and men, gender differences were found for nocebo rates. In the conclusion, we discuss potential implications for clinical trial designs and argue for interventions aimed at optimizing positive expectations of treatment benefit while minimizing the impact of adverse effects.

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“…GPs have been shown to recognize only 40-50% of their patients with a current depressive disorder [18,16,12]. And if recognized, only a few of depressed patients receive antidepressant treatment of proven effectiveness [12,15,8,9,11,13].…”

Section: Introductionmentioning

confidence: 99%

The care provided by general practitioners for persistent depression

Brink

Meer

et al. 2006

Eur. psychiatr.

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Purpose.To examine the care provided by general practitioners (GPs) for persistent depressive illness and its relationship to patient, illness and consultation characteristics.Subjects and method.Using the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC) a sample of 264 patients with ICD-10 depression was identified among consecutive primary care patients in the Netherlands. At 1-year follow-up 78 of these patients (30%) still fulfilled the criteria of an ICD-10 depression and were considered persistent cases. At baseline and follow-up the GPs specified their diagnosis and treatment. The extent of recognition as a mental health problem, accuracy of diagnosis as a depression and treatment in accordance with clinical guidelines for depression was examined. In addition it was examined whether these steps in adequate GP care for persistent depression were related to patient, illness and consultation characteristics.Results.Twenty percent of the persistent depression cases were not recognized at baseline or during follow-up, 28% was recognized but not accurately diagnosed, 17% was accurately diagnosed, but did not receive adequate treatment and 35% was treated adequately. Recognition was associated with psychological reason for encounter; accurate diagnosis with absence of activity limitation days; and adequate treatment with severity of depression and higher educational level.Conclusion.Non-recognition, misdiagnosis and inadequate treatment are not limited to patients with a relatively mild and brief depression but are also prominent in patients with a persistent depression, who consulted their GP 8.2 times on average during the year their depression persisted.

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The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared

Cited by 136 publications

References 15 publications

Anti-depressants, suicide, and drug regulation

Anti-depressants, suicide, and drug regulation

Lessons learned from placebo groups in antidepressant trials

The care provided by general practitioners for persistent depression

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