Use of antidepressants in the treatment of depression in Asia: Guidelines, clinical evidence, and experience revisited

Abstract

Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence-based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence-based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients.

Multinational comparison of new antidepressant use in older adults: a cohort study

“…The reason for these differences in approach is not clear. They may represent an innate conservatism in the use of antidepressants in the Taiwanese population where there is an acknowledged absence of evidence to support clinical guidelines,53 or known differences in genetic determinants of drug metabolism that have been established in population-based genomic studies of drug metabolism 54…”

Olanzapine in Chinese patients with schizophrenia or bipolar disorder: a systematic literature review

“…A recent review of Asian guidelines for depression noted that most recommendations are based on consensus derived from Western research data 116. The discrepancy between the context in which these recommendations are developed and local practices and circumstances may underlie their failure to be implemented.…”

Real‐world outcomes in patients with depression treated with duloxetine or a selective serotonin reuptake inhibitor in East Asia

“…Several international guidelines, issued by American Psychiatric Association (APA, ), British Association of Psychopharmacology (Anderson et al ., ), and Canadian Network for Mood and Anxiety Treatments (Lam et al ., ), for example, have recommended both selective serotonin reuptake inhibitors (SSRIs) and serotonin‐norepinephrine reuptake inhibitors (SNRIs) as first‐line treatments for MDD. These recommendations have also been adopted in several Asian countries (Treuer et al ., ).…”