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Second-Generation Antidepressants for Treating Adult Depression—An Update

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Agency for Healthcare Research and Quality (AHRQ) Comparative Effectiveness Review (CER) Development

Topics are nominated through a public process, which includes submissions from health care professionals, professional organizations, the private sector, policymakers, the public, and others. A systematic review of all relevant clinical studies is conducted by independent researchers, who are funded by AHRQ, to synthesize the evidence in a report summarizing what is known and not known about the select clinical issue. The research questions and the results of the report are subject to expert input, peer review, and public comment. The results of these reviews are summarized into Clinician Research Summaries and Consumer Research Summaries for use in decisionmaking and in discussions with patients. The research reviews and the full report, with references for included and excluded studies, are available at www.effectivehealthcare.ahrq.gov/secondgenantidep.cfm.

The purpose of presentation is to help policymakers, clinicians, and patients make informed choices about the use of second-generation antidepressants. Given the prominent role of drug therapy in psychiatric disease and the prevalent use of these drugs, thi spresentation will summarize comparative data on the efficacy, effectiveness, and harms of 13 newer antidepressants: bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine. This presentation will evaluate evidence for these agents in treating patients with depressive syndrome, including major depressive disorder, dysthymic disorder, and subsyndromal depressive disorders, as defined by the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) when used in adults 18 years of age and older, including the elderly. The data from the comparative effectiveness review (CER) updates a previous report (January 2007) by including new evidence published since the latest date of publications in the original review. One new medication (desvenlafaxine) and comparisons of different formulations of the same chemical entity have been included. Additionally, the CER examined whether switching medications after a successful response to an initial medication increases the risk of relapse or recurrence. This question is especially relevant to patients who face changes in their insurance benefit when their insurers no longer cover the medication they are currently taking.