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Healthy Skepticism Library item: 9276

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Zetin M, Hoepner CT, Bjornson L.
Rational antidepressant selection: applying evidence-based medicine to complex real-world patients.
Psychopharmacol Bull 2006; 39:(1):38-104
http://www.medworksmedia.com/psychopharmbulletin/pdf/18/038-104_PB_V39N1_Zetin.pdf


Abstract:

Every clinician faces the daily question of which antidepressant is best for a particular depressed patient. Double-blind studies submitted for U.S. Federal Drug Administration marketing approval include only the “purest” population of patients, and the American Psychiatric Association and other treatment guidelines often do not adequately address the complexities of developmental, family history, psychosocial, medical, and psychiatric comorbidity, and treatment-refractory issues that are seen in routine clinical practice. Long-term trends in depression treatment include ever-expanding choices among drugs, highly specific psychotherapies, and attempts to treat chronic and/or mild cases, with the goal of remission for all patients.We performed literature reviews and attempted to synthesize factors that may be useful in the application of evidence-based medicine in office-based psychiatric practice.We have found that factors influencing antidepressant selection include drug factors (including tolerability, interactions, and cost), depression subtype, psychiatric and medical comorbidity, and stage of life. In addition, patient preference for avoiding certain side effects and personal and family history of treatment response are helpful information. Most patients in the community would not fit strict antidepressant study criteria. Biologic markers predicting treatment response are not yet widely available, so the optimal choice of medication must be guided by detailed history.

Keywords:
antidepressant, depression, remission, comorbidity, clinical response, treatment Publication Types: Review MeSH Terms: Antidepressive Agents/adverse effects Antidepressive Agents/therapeutic use* Comorbidity Depressive Disorder/diagnosis Depressive Disorder/drug therapy* Depressive Disorder/psychology Evidence-Based Medicine* Humans Medical History Taking Practice Guidelines Randomized Controlled Trials Treatment Outcome Substances: Antidepressive Agents


Notes:

Free full text (.pdf)

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909