Navigation Links
Antidepressants do work in depression while evidence for CBT is poorer say experts
Date:5/6/2008

Los Angeles, London, New Delhi, and Singapore (6 May, 2008) A new revision of clinical guidelines to help doctors manage patients with depression has challenged the rationale behind the UK governments policy of rolling out of cognitive behavioural therapy (CBT) for milder depression.

According to a comprehensive review of treatments for depression, there is a lack of evidence for CBT being more helpful than other forms of psychological support in mild depression or for its efficacy in severe depression. There is also good evidence for antidepressants being effective in depression, with benefit increasing the more severe the depression. This is contrary to recent reports that antidepressants dont work except in the most severe depression.

Dr Ian Anderson, Senior Lecturer and Honorary Consultant Psychiatrist, Neuroscience and Psychiatry Unit, University of Manchester, UK, says the cost effectiveness of CBT should be thoroughly investigated before it is adopted more widely because it is likely to be offered to people with milder depression where the evidence is poorest.

There is often not a level playing field in considering evidence for drugs versus psychological treatment, especially in milder depression, Dr Anderson explains, adding that specific psychological treatments are relatively expensive compared to drug treatments because treatment involves training of the therapists as well as the costs of administering the intervention.

To measure the effectiveness of these treatments requires comparison against appropriate control treatment like non-specific supportive treatment in the same way drugs are compared against placebo, says Dr Anderson. This is important given the rolling out of CBT for milder depression probably less expensive means of support are more cost-effective.

This conclusion is just one of the issues to emerge from a comprehensive review of the evidence for various forms of management of depression, conducted as part of a revision of the 2000 British Association for Psychopharmacology evidence-based guidelines, and published this week by SAGE in the Journal of Psychopharmacology. The aim of the review was to incorporate new evidence and to update the recommendations where appropriate.

Revisions to the guidelines were agreed after a consensus meeting involving experts in depressive disorders and their management, user representatives, and medical and scientific staff from pharmaceutical companies in May 2006 and a subsequent literature review.

The new guidelines also question whether CBT should routinely be combined with antidepressant medication for depression in adolescentsas the UKs National Institute for Health and Clinical Excellence suggestsciting a lack of evidence. Dr Anderson says some recommendations run contrary to NICE guidance:

  • First, the choice between antidepressants and CBT needs to be individually decided rather than routinely recommending CBT first.
  • Second, combining CBT with antidepressants should not be routine.

He suggests that doctors should try to adopt a more dimensional approach to depression rather than over-emphasising categories of disease severity such as not depressed, clinical depression, etc, or relying too heavily on cut-off points such as simply counting symptoms. It is important to consider an individual patients situation in a more rounded fashion such as past history, degree of impairment, duration of symptoms and risk of relapse.

Overall, the guidelines clear up some issues and alter the emphasis on certain treatments for example suggesting that for subthreshold depression, which is not of clinical severity, antidepressants should be considered if it lasts more than 2-3 months, Dr Anderson says. We have also challenged the idea that antidepressants need to be given more than once a day or that for most antidepressants you need to follow a long tailing off before starting a new antidepressant.

We hope [the guidelines] will set a standard. We have tried to be practical in our advice and addressed issues that other guidelines tend not to be specific about such as managing side-effects of antidepressants. We want to help doctors and patients choose treatments and strategies that have the best chance of helping, Dr Anderson concludes.


'/>"/>

Contact: Mithu Mukherjee
mithu.mukherjee@sagepub.co.uk
020-732-42223
SAGE Publications UK
Source:Eurekalert

Related medicine news :

1. A link between antidepressants and type 2 diabetes
2. FDA Warning of Suicidal Risk Associated with Antidepressants in Juveniles and Young Adults Reviewed at Recent ISCTM Meeting
3. Only Severely Depressed Benefit From Antidepressants: Study
4. As depression symptoms improve with antidepressants, hopelessness can linger
5. Antidepressants Can Increase Depression, Impulsivity and Suicide Risk by Decreasing Dopamine
6. Antidepressants that are more efficient and faster
7. Genetics May Determine Antidepressants Effectiveness
8. Antidepressants Help HIV-Infected Patients Stick to Treatment
9. Study shows new strategy for developing antidepressants
10. Antidepressants Boost GI Bleeding Risk
11. Antidepressants and painkillers - a dangerous combination
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/28/2016)... ... April 28, 2016 , ... Accreditation Commission for ... Pharmacy Association (COPA) to develop a comprehensive Specialty Pharmacy Accreditation with Distinction in ... accreditation distinction. ACHC provides a wide range of pharmacy accreditation services that assess ...
(Date:4/28/2016)... ... April 28, 2016 , ... The Aging in Motion Coalition ... ICD-10-CM code for sarcopenia, giving it recognition for separate reporting and data collection. The ... 2016. , Sarcopenia is defined as a combination of low muscle mass and weakness ...
(Date:4/28/2016)... ... April 28, 2016 , ... The USDA recently released its updated Dietary Guidelines ... science. While there is a lot of information available in the report, older men ... 2016 issue of Harvard Men's Health Watch . , These include: , ...
(Date:4/28/2016)... ... April 28, 2016 , ... Dr. Farhan Qureshi has ... been named a 2015 Top Rated Alexandria Dentist from Find Local ... has received across many credible sources. Find Local Doctors is an online directory that ...
(Date:4/28/2016)... ... April 28, 2016 , ... Vigamox and other pink eye medications ... contagious infection of the mucus membrane of the eye. This membrane, the conjunctiva, ... eye, also called conjunctivitis, can be caused by a virus, bacteria, extreme dryness, chemicals ...
Breaking Medicine News(10 mins):
(Date:4/28/2016)... , April 28, 2016 Research ... "Global Plastic Surgery Products Market 2016-2020" report to ... ) , The global plastic surgery products ... 9.47% during the period 2016-2020. , ,The growing adoption ... to the growth of the market. Lasers are used ...
(Date:4/28/2016)... , Net Sales of $1.90 billion represent ... prior year period, and an increase of 1.2% on an ... for the first quarter were $0.52 reported, a decrease of ... increase of 29.9% over the prior year period , ... for 2016 Zimmer Biomet Holdings, Inc. (NYSE and ...
(Date:4/28/2016)... , April 28, 2016 ... development of innovative peptide and gene-based immunotherapeutics and vaccines for ... will be presenting at the 3rd Annual Growth Capital ... 5 th , 2016 at Caesars Palace in Las Vegas, Nevada.  ... am on Wednesday, May 4 th by Dr. ...
Breaking Medicine Technology: