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Second-Generation Antidepressants for Treating Adult Depression—An Update
Gaps in Knowledge (2 of 2)
The research from the comparative effectiveness review identified these gaps in knowledge:
- The general efficacy of second-generation antidepressants for treating dysthymia and subsyndromal depression.
- Differences in benefits and harms in subgroups such as the very elderly or patients with common comorbidities.
- The most appropriate duration of antidepressant treatment for maintaining remission.
- The effect of drug dose on the risk of relapse or recurrence.
- The effect of switching to a new drug after successful completion of acute-phase or continuation-phase treatment.
- The most effective second-generation antidepressant in patients who either did not respond or could not tolerate a first-line treatment.
- How combinations of antidepressants compare with monotherapy in treatment-resistant depression.
- How outcomes of second-generation antidepressants differ in populations with accompanying symptoms such as anxiety, insomnia, pain, or fatigue.
- The comparative risks of second-generation antidepressants with respect to rare but serious adverse effects such as suicidality, hyponatremia, hepatotoxicity, seizures, cardiovascular adverse events, and serotonin syndrome.
Keywords: gaps in knowledge | effectiveness | combination therapy | anxiety | insomnia | pain | fatigue | serious adverse effects | suicidality
- 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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