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

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

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