0
Sign In  | Subscribe
18 November 2008, Vol 149, No. 10>
Summaries for Patients | 18 November 2008

Use of Drugs to Treat Depression: Guidelines from the American College of Physicians FREE

[+] Article and Author Information

The summary below is from the full reports titled “Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians” and “Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians.” They are in the 18 November 2008 issue of Annals of Internal Medicine (volume 149, pages 725-733 and pages 734-750). The first report was written by A. Qaseem, V. Snow, T.D. Denberg, M.A. Forciea, and D.K. Owens, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians; the second report was written by 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.


Ann Intern Med. 2008;149(10):I-56. doi:10.7326/0003-4819-149-10-200811180-00002
Text Size: A A A

Who developed these guidelines?

The American College of Physicians (ACP) developed these recommendations. Members of the ACP are internists, specialists in the care of adults.

What is the problem and what is known about it so far?

Depression causes sadness that interferes with daily life. Depression is a medical condition, not a normal reaction to such life situations as the death of a loved one or the loss of a job. About 1 out of every 5 people has depression at some time in his or her life. Common depression symptoms are lack of energy and loss of interest in things previously enjoyed. Often, people with depression do not realize that their feelings are due to a medical condition and do not seek medical care. Many depressed people need treatment with counseling or drugs.

Several types of drugs are available to treat depression. Newer, “second-generation” drugs are often used to treat depression because they are effective and have fewer side effects than older, “first-generation” drugs. Nonetheless, antidepressant drug therapy may relieve some but not all symptoms and may cause troublesome adverse effects. If an antidepressant drug does not work well, doctors sometimes switch to another drug or add a second drug.

How did the ACP develop these recommendations?

The authors reviewed published studies about the benefits and harms of drugs used to treat depression. The reviewers focused on second-generation antidepressants—bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazadone, and venlafaxine (generic names).

What did the authors find?

On the basis of more than 200 studies, no substantial differences in efficacy or effectiveness for the treatment of depression were found among second-generation depression drugs. Specific drugs differed in the frequency of specific side effects. Studies suggested that patients with a first episode of depression should take the drugs for 4 to 9 months to lower the chances of the depression coming back. Patients with 2 or more episodes of depression may benefit from longer treatment.

What does the ACP suggest that patients and doctors do?

When drugs are used to treat depression, doctors and patients should select a second-generation antidepressant on the basis of side effect profiles, cost, and patient preferences.

When drugs are used to treat depression, doctors should follow patients on a regular basis to check on response to treatment and side effects. This follow-up should begin within 1 to 2 weeks after the patient first receives the drug.

If a patient's depression does not improve within 6 to 8 weeks of starting drug treatment, doctors should either increase the dose or switch to a different drug.

Patients with a first episode of depression that goes away with drug treatment should continue the drug for another 4 to 9 months to decrease the chance that the depression will come back. Patients who have had 2 or more episodes of depression may need to continue the drug for more than 9 months.

What are the cautions related to these recommendations?

These recommendations may change as new research is done.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general jounals
BMJ 2010;341:c5893-c1494.

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Want to Subscribe?

Learn more about subscription options

Register Now for a free account
Advertisement

Related Content

Customize your page view by dragging & repositioning the boxes below.

PubMed Articles
A controlled clinical treatment trial of interpersonal psychotherapy for depressed pregnant women at 3 New York City sites.
The Journal of clinical psychiatry Issue date: 2013 Apr
Symptom Management in Patients With Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
Chest Issue date: 2013 May

Annals of Internal Medicine

Other Resources

Copyright © 2013 The American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Want to Subscribe?

Learn more about subscription options

Register Now for a free account
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)