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Antidepressant efficacy and side-effect burden: a quick guide for clinicians.

Daniel Santarsieri¹, Thomas L Schwartz¹

¹Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA.

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|November 18, 2015

Summary

Antidepressant treatment (ADT) for major depressive disorder (MDD) has risen due to safer drugs and reduced stigma. This paper reviews evidence supporting ADT, from FDA approvals to pharmacodynamic principles.

Keywords:

antidepressants depression effectiveness efficacy pharmacodynamics pharmacotherapy psychotropics safety

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Area of Science:

Psychiatry
Pharmacology
Clinical Medicine

Background:

Prescribing of antidepressant treatment (ADT) for major depressive disorder (MDD) has significantly increased over the past two decades.
Factors contributing to this rise include safer medications, improved clinician and patient education, direct-to-consumer marketing, and reduced societal stigma.
Despite increased use, the safety and effectiveness of ADT remain subjects of ongoing discussion and scrutiny.

Purpose of the Study:

To critically evaluate the evidence base supporting the use of ADT in treating MDD.
To delineate the different tiers of evidence, including regulatory approvals, empirical trial data, and theoretical underpinnings.
To compare standard psychopharmacology guideline approaches with less common treatment practices.

Main Methods:

Review of evidence supporting ADT, categorized into three levels: (A) Food and Drug Administration (FDA) approvals, (B) randomized controlled trials (RCTs) and meta-analyses, and (C) theoretical pharmacodynamic principles.
Application of pharmacodynamic principles to guide antidepressant selection when higher-level evidence is limited.
Analysis of current psychopharmacology guidelines to distinguish standard care from non-standard practices.

Main Results:

The paper outlines a hierarchical approach to assessing ADT efficacy, starting with FDA approvals.
It highlights the importance of RCTs and meta-analyses as robust evidence for treatment effectiveness.
Where empirical data is scarce, pharmacodynamic rationale is presented as a justifiable method for treatment choice.

Conclusions:

The evidence supporting ADT for MDD varies, necessitating a careful evaluation of different data sources.
Understanding the levels of evidence is crucial for informed clinical decision-making in antidepressant prescribing.
Distinguishing between standard and non-standard care, guided by evidence and established guidelines, is essential for optimizing patient outcomes.