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Statements

Subject Item
n2:RIV%2F00023752%3A_____%2F12%3A43913792%21RIV13-MZ0-00023752
rdf:type
skos:Concept n16:Vysledek
rdfs:seeAlso
http://dx.doi.org/10.1016/j.eurpsy.2011.08.002
dcterms:description
This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5-7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of 'the right drug/treatment for the right patient' is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact. (C) 2011 Elsevier Masson SAS. All rights reserved. This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5-7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of 'the right drug/treatment for the right patient' is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact. (C) 2011 Elsevier Masson SAS. All rights reserved.
dcterms:title
Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression
skos:prefLabel
Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression
skos:notation
RIV/00023752:_____/12:43913792!RIV13-MZ0-00023752
n16:predkladatel
n19:ico%3A00023752
n3:aktivita
n12:V n12:N
n3:aktivity
N, V
n3:cisloPeriodika
2
n3:dodaniDat
n5:2013
n3:domaciTvurceVysledku
n14:1371576
n3:druhVysledku
n15:J
n3:duvernostUdaju
n13:S
n3:entitaPredkladatele
n6:predkladatel
n3:idSjednocenehoVysledku
159915
n3:idVysledku
RIV/00023752:_____/12:43913792
n3:jazykVysledku
n18:eng
n3:klicovaSlova
evidence based medicine; antidepressants; clinical experience
n3:klicoveSlovo
n4:antidepressants n4:clinical%20experience n4:evidence%20based%20medicine
n3:kodStatuVydavatele
FR - Francouzská republika
n3:kontrolniKodProRIV
[3D91F9709BB8]
n3:nazevZdroje
European Psychiatry
n3:obor
n10:FL
n3:pocetDomacichTvurcuVysledku
1
n3:pocetTvurcuVysledku
6
n3:rokUplatneniVysledku
n5:2012
n3:svazekPeriodika
27
n3:tvurceVysledku
Kasper, S. Fountoulakis, K. Möller, H J Bitter, I. Bobes, J. Höschl, Cyril
n3:wos
000300397000005
s:issn
0924-9338
s:numberOfPages
15
n7:doi
10.1016/j.eurpsy.2011.08.002