 |
 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
2 May 2000 | Volume 132 Issue 9 | Pages 743-756
Background: Depressive disorders are persistent, recurring illnesses that cause great suffering for patients and their families.
Purpose: To evaluate the benefits and adverse effects of newer pharmacotherapies and herbal treatments for depressive disorders in adults and adolescents.
Data Sources: English-language and non-English-language literature from 1980 to January 1998 was identified from a specialized registry of controlled trials, meta-analyses, and experts.
Study Selection: Randomized trials evaluating newer antidepressants (such as serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and St. John's wort) that reported clinical outcomes were selected.
Data Extraction: Two persons independently abstracted data that were then synthesized descriptively; some data were pooled by using a random-effects model.
Data Synthesis: Of 315 eligible trials, most evaluated antidepressants in adults with major depression, were conducted among outpatients, and examined acute-phase treatment. Newer antidepressants were more effective than placebo for major depression (relative benefit, 1.6 [95% CI, 1.5 to 1.7]) and dysthymia (relative benefit, 1.7 [CI, 1.3 to 2.3]). They were effective among older adults and primary care patients. Efficacy did not differ among newer agents or between newer and older agents. Hypericum (St. John's wort) was more effective than placebo for mild to moderate depression (risk ratio, 1.9 [CI, 1.2 to 2.8]), but publication bias may have inflated the estimate of benefit. Newer and older antidepressants did not differ for overall discontinuation rates, but side effect profiles varied significantly. Data were insufficient for determining the efficacy of newer antidepressants for subsyndromal depression, depression with coexisting medical or psychiatric illness, or depression in adolescents.
Conclusions: Newer antidepressants are clearly effective in treating depressive disorders in diverse settings. Because of similar efficacy, both newer and older antidepressants should be considered when making treatment decisions. Better information is urgently needed on the efficacy of newer antidepressants in patients with nonmajor depression and in special populations, including adolescents.
Author and Article Information
From the South Texas Veterans Health Care System, Audie Murphy Division and the San Antonio Evidence-based Practice Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
For other ACP-ASIM Clinical Practice Guidelines, see http://www.acponline.org/sci-policy/guidelines.
Grant Support: By the Agency for Healthcare Research and Quality, contract #290-97-0012. Dr. Williams is a recipient of a Veterans Affairs Health Services Research Career Development Award.
Acknowledgments: The authors thank Drs. Robert Badgett, Valerie Lawrence, W. Scott Richardson, and Madhukar Tirvedi, who contributed content to the original report on which this manuscript is based; the project staff with the San Antonio Evidence-based Practice Center; the 11-member technical advisory panel; and the peer reviewers who provided helpful suggestions that improved the manuscript.
Requests for Single Reprints: John W. Williams Jr., MD, MHS, Department of Medicine, Mail Code 7879, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Drs. Williams, Mulrow, Aguilar, and Cornell: Department of Medicine, Mail Code 7879, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900.
Dr. Chiquette: 8000 Oakdell Way, #1508-3, San Antonio, TX 78240. POSITION PAPER
A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary: Clinical Guideline, Part 2
This article has been cited by other articles:
|
|
 |
|
  G. Gartlehner, B. N. Gaynes, R. A. Hansen, P. Thieda, A. DeVeaugh-Geiss, E. E. Krebs, C. G. Moore, L. Morgan, and K. N. Lohr Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians Ann Intern Med, November 18, 2008; 149(10): 734 - 750. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. E. Krebs, B. N. Gaynes, G. Gartlehner, R. A. Hansen, P. Thieda, L. C. Morgan, A. DeVeaugh-Geiss, and K. N. Lohr Treating the Physical Symptoms of Depression With Second-Generation Antidepressants: A Systematic Review and Metaanalysis Psychosomatics, May 1, 2008; 49(3): 191 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Barbui MD, T. A. Furukawa MD, and A. Cipriani MD Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials Can. Med. Assoc. J., January 29, 2008; 178(3): 296 - 305. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Saag Mend the Mind, but Mind the Bones!: Balancing Benefits and Potential Skeletal Risks of Serotonin Reuptake Inhibitors Arch Intern Med, June 25, 2007; 167(12): 1231 - 1232. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Goldberg and L. B. Andrew Lincoln's Melancholy: How Depression Challenged a President and Fueled His Greatness JAMA, May 9, 2007; 297(18): 2033 - 2034. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Z. Bambauer, D. G. Safran, D. Ross-Degnan, F. Zhang, A. S. Adams, J. Gurwitz, M. Pierre-Jacques, and S. B. Soumerai Depression and Cost-Related Medication Nonadherence in Medicare Beneficiaries Arch Gen Psychiatry, May 1, 2007; 64(5): 602 - 608. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. B. Raymond, S. G. Morgan, and P. A. Caetano Antidepressant Utilization in British Columbia From 1996 to 2004: Increasing Prevalence but Not Incidence Psychiatr Serv, January 1, 2007; 58(1): 79 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Sernyak and R. A. Rosenheck Generic Fluoxetine and Choice of Antidepressant Medication Psychiatr Serv, January 1, 2007; 58(1): 128 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Wang, A. Patrick, J. Avorn, F. Azocar, E. Ludman, J. McCulloch, G. Simon, and R. Kessler The Costs and Benefits of Enhanced Depression Care to Employers Arch Gen Psychiatry, December 1, 2006; 63(12): 1345 - 1353. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Valenstein, J. F. McCarthy, K. L. Austin, J. F. Greden, E. A. Young, and F. C. Blow What Happened to Lithium? Antidepressant Augmentation in Clinical Settings Am J Psychiatry, July 1, 2006; 163(7): 1219 - 1225. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Miller, S. M. Adams, and M. M. Miller Antidepressant medication use in palliative care American Journal of Hospice and Palliative Medicine, March 1, 2006; 23(2): 127 - 133. [Abstract] [PDF]
|
|
|
|
 |
|
 U. WERNEKE, T. TURNER, and S. PRIEBE Complementary medicines in psychiatry: Review of effectiveness and safety The British Journal of Psychiatry, February 1, 2006; 188(2): 109 - 121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Hansen, G. Gartlehner, K. N. Lohr, B. N. Gaynes, and T. S. Carey Efficacy and Safety of Second-Generation Antidepressants in the Treatment of Major Depressive Disorder Ann Intern Med, September 20, 2005; 143(6): 415 - 426. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Arroll, S. Macgillivray, S. Ogston, I. Reid, F. Sullivan, B. Williams, and I. Crombie Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis Ann. Fam. Med, September 1, 2005; 3(5): 449 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W Williams Jr and T. Holsinger St John's for depression, worts and all BMJ, May 14, 2005; 330(7500): E350 - E351. [Full Text] [PDF]
|
|
|
|
|
|
D. G. Blazer, C. F. Hybels, G. G. Fillenbaum, and C. F. Pieper Predictors of Antidepressant Use Among Older Adults: Have They Changed Over Time? Am J Psychiatry, April 1, 2005; 162(4): 705 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Tinetti, H. Allore, K. L. B. Araujo, and T. Seeman Modifiable Impairments Predict Progressive Disability Among Older Persons J Aging Health, April 1, 2005; 17(2): 239 - 256. [Abstract] [PDF]
|
|
|
|
|
|
K. LINDE, M. BERNER, M. EGGER, and C. MULROW St John's wort for depression: Meta-analysis of randomised controlled trials The British Journal of Psychiatry, February 1, 2005; 186(2): 99 - 107. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Vos, M. M. Haby, J. J. Barendregt, M. Kruijshaar, J. Corry, and G. Andrews The Burden of Major Depression Avoidable by Longer-term Treatment Strategies Arch Gen Psychiatry, November 1, 2004; 61(11): 1097 - 1103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Williams Jr., W. Katon, E. H.B. Lin, P. H. Noel, J. Worchel, J. Cornell, L. Harpole, B. A. Fultz, E. Hunkeler, V. S. Mika, et al. The Effectiveness of Depression Care Management on Diabetes-Related Outcomes in Older Patients Ann Intern Med, June 15, 2004; 140(12): 1015 - 1024. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. S. SCHNEIDER, J. C. NELSON, C. M. CLARY, P. NEWHOUSE, K. R. R. KRISHNAN, T. SHIOVITZ, and K. WEIHS Dr. Schneider and Colleagues Reply Am J Psychiatry, April 1, 2004; 161(4): 759 - 761. [Full Text]
|
|
|
|
|
|
T. Helgason, H. Tomasson, and T. Zoega Antidepressants and public health in Iceland: Time series analysis of national data The British Journal of Psychiatry, February 2, 2004; 184(2): 157 - 162. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Weilburg, K. M. O'Leary, J. B. Meigs, J. Hennen, and R. S. Stafford Evaluation of the Adequacy of Outpatient Antidepressant Treatment Psychiatr Serv, September 1, 2003; 54(9): 1233 - 1239. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. MacGillivray, B. Arroll, S. Hatcher, S. Ogston, I. Reid, F. Sullivan, B. Williams, and I. Crombie Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis BMJ, May 10, 2003; 326(7397): 1014 - 1014. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Parker, K. Roy, and K. Eyers Cognitive Behavior Therapy for Depression? Choose Horses for Courses Am J Psychiatry, May 1, 2003; 160(5): 825 - 834. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Linde and S. N Willich How objective are systematic reviews? Differences between reviews on complementary medicine J R Soc Med, January 1, 2003; 96(1): 17 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A.G.M. De Smet Herbal Remedies N. Engl. J. Med., December 19, 2002; 347(25): 2046 - 2056. [Full Text] [PDF]
|
|
|
|
|
|
W. Jonas, D. Wheatley, G. I. Spielmans, A. Volp, K. Linde, D. Melchart, C. D. Mulrow, M. Berner, J. Cott, K. L. Wisner, et al. St John's Wort and Depression JAMA, July 24, 2002; 288(4): 446 - 449. [Full Text] [PDF]
|
|
|
|
|
|
K. Kroenke A 75-Year-Old Man With Depression JAMA, March 27, 2002; 287(12): 1568 - 1576. [Full Text] [PDF]
|
|
|
|
|
|
E. Ernst The Risk-Benefit Profile of Commonly Used Herbal Therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava Ann Intern Med, January 1, 2002; 136(1): 42 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kroenke, S. L. West, R. Swindle, A. Gilsenan, G. J. Eckert, R. Dolor, P. Stang, X.-H. Zhou, R. Hays, and M. Weinberger Similar Effectiveness of Paroxetine, Fluoxetine, and Sertraline in Primary Care: A Randomized Trial JAMA, December 19, 2001; 286(23): 2947 - 2955. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. PARKER New' and old' antidepressants: all equal in the eyes of the lore? The British Journal of Psychiatry, August 1, 2001; 179(2): 95 - 96. [Full Text] [PDF]
|
|
|
|
 |
|
 A. H. FRIEDLANDER and M. E. MAHLER Major depressive disorder: Psychopathology, medical management and dental implications J Am Dent Assoc, May 1, 2001; 132(5): 629 - 638. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. M Anderson Meta-analytical studies on new antidepressants Br. Med. Bull., March 1, 2001; 57(1): 161 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Freeny, J. Leard-Hansson, B. Terluin, H. van Hout, and J. W. Williams, Jr Treatment of Mild Depression in Elderly Patients JAMA, December 20, 2000; 284(23): 2993 - 2994. [Full Text] [PDF]
|
|
|
|
|
|
E Ernst The role of complementary and alternative medicine BMJ, November 4, 2000; 321(7269): 1133 - 1135. [Full Text]
|
|
|
|
 |
|
 R. Bullock Review: newer and older antidepressants are effective in primary care and elderly patients with depressive disorders Evid. Based Ment. Health, November 1, 2000; 3(4): 118 - 118. [Full Text]
|
|
|
|
 |
|
 Other articles noted Evid. Based Nurs., October 1, 2000; 3(4): 106 - 112. [Full Text]
|
|
Article
