Second-Generation Antidepressants for Treating Adult Depression—An Update
Overall Comparative Effectiveness of Second-Generation Antidepressants for Treating Major Depressive Disorder
In all, 91 RCTs (reported in 93 articles) compared the efficacy or effectiveness of one second-generation antidepressant with that for another for treating patients with major depressive disorder (MDD). Most subjects were younger than 60 years; 11 trials were conducted in populations 55 years of age or older. In general, studies enrolled patients according to a criteria-based diagnosis of MDD relating to the Diagnostic and Statistical Manual of Mental Disorders (either the revised third edition [DSM-III-R] or fourth edition [DSM-IV]) and a predefined cutoff point of a widely used depression scale (i.e., Hamilton Rating Scale for Depression [HAM-D] =18 or Montgomery-Asberg Depression Rating Scale [MADRS] =19). Most patients had moderate to severe depression as measured by a variety of scales. Most studies excluded patients who had additional axis I disorders, high suicidal risk, or progressive medical diseases or who used psychotherapy, electroconvulsive therapy, or psychotropic medications. In the majority of studies, the primary end points were either changes from baseline or rates of response or remission on investigator-rated diagnostic depression scales such as the HAM-D or MADRS. Changes on such diagnostic depression scales are generally viewed as intermediate outcomes rather than health outcomes, and they are not always reliably related to changes in health outcomes. Response or remission, even when deducted from such a scale (e.g., response is defined as a 50% improvement of scores on the HAM-D or the MADRS), can be seen as proxies to health outcomes. Therefore, reporting of outcomes is focused on differences in response or remission rates rather than differences in changes of scores.
This portion (slides 11–14) of the presentation addreses the comparative effectiveness of second-generation antidepressants for treating adults with MDD. The overall comparative effectiveness results will be addressed first, followed by the results from the immediate-release and extended-release formulations and the results related to treatment adherence and persistence.
- Gartlehner G, Hansen RA, Morgan LC, et al. Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review. Comparative Effectiveness Review No. 46 (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2007-10056-I). Rockville, MD: Agency for Healthcare Research and Quality; December 2011. AHRQ Publication No. 12-EHC012-EF. Available at www.effectivehealthcare.ahrq.gov/secondgenantidep.cfm.
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