General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA section of pharmacopsychiatry

  • Thomas C. Baghai
  • Pierre Blier
  • David S. Baldwin
  • Michael Bauer
  • Guy M. Goodwin
  • Kostas N. Fountoulakis
  • Siegfried Kasper
  • Brian E. Leonard
  • Ulrik F. Malt
  • Dan Stein
  • Marcio Versiani
  • Hans-Jürgen Möller
  • for the Section of Pharmacopsychiatry, World Psychiatric Association
Original Paper

DOI: 10.1007/s00406-011-0259-6

Cite this article as:
Baghai, T.C., Blier, P., Baldwin, D.S. et al. Eur Arch Psychiatry Clin Neurosci (2011) 261(Suppl 3): 207. doi:10.1007/s00406-011-0259-6
  • 699 Downloads

Abstract

Current gold standard approaches to the treatment of depression include pharmacotherapeutic and psychotherapeutic interventions with social support. Due to current controversies concerning the efficacy of antidepressants in randomized controlled trials, the generalizability of study findings to wider clinical practice and the increasing importance of socioeconomic considerations, it seems timely to address the uncertainty of concerned patients and relatives, and their treating psychiatrists and general practitioners. We therefore discuss both the efficacy and clinical effectiveness of antidepressants in the treatment of depressive disorders. We explain and clarify useful measures for assessing clinically meaningful antidepressant treatment effects and the types of studies that are useful for addressing uncertainties. This includes considerations of methodological issues in randomized controlled studies, meta-analyses, and effectiveness studies. Furthermore, we summarize the differential efficacy and effectiveness of antidepressants with distinct pharmacodynamic properties, and differences between studies using antidepressants and/or psychotherapy. We also address the differential effectiveness of antidepressant drugs with differing modes of action and in varying subtypes of depressive disorder. After highlighting the clinical usefulness of treatment algorithms and the divergent biological, psychological, and clinical efforts to predict the effectiveness of antidepressant treatments, we conclude that the spectrum of different antidepressant treatments has broadened over the last few decades. The efficacy and clinical effectiveness of antidepressants is statistically significant, clinically relevant, and proven repeatedly. Further optimization of treatment can be helped by clearly structured treatment algorithms and the implementation of psychotherapeutic interventions. Modern individualized antidepressant treatment is in most cases a well-tolerated and efficacious approach to minimize the negative impact of otherwise potentially devastating and life-threatening outcomes in depressive disorders.

Keywords

Antidepressant treatments Depression Pharmacological treatments Psychotherapy 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Thomas C. Baghai
    • 1
    • 2
  • Pierre Blier
    • 3
  • David S. Baldwin
    • 4
  • Michael Bauer
    • 5
  • Guy M. Goodwin
    • 6
  • Kostas N. Fountoulakis
    • 7
  • Siegfried Kasper
    • 8
  • Brian E. Leonard
    • 9
  • Ulrik F. Malt
    • 10
  • Dan Stein
    • 11
  • Marcio Versiani
    • 12
  • Hans-Jürgen Möller
    • 1
  • for the Section of Pharmacopsychiatry, World Psychiatric Association
  1. 1.Department of Psychiatry and PsychotherapyLudwig-Maximilian-University of MunichMunichGermany
  2. 2.Department of Psychiatry and PsychotherapyUniversity RegensburgRegensburgGermany
  3. 3.Department of PsychiatryUniversity of OttawaOttawaCanada
  4. 4.University Department of PsychiatryUniversity of SouthamptonSouthamptonUK
  5. 5.University Hospital Carl Gustav CarusDresdenGermany
  6. 6.University DepartmentWarneford HospitalOxfordUK
  7. 7.3rd Department of PsychiatryAristotle University of ThessalonikiThessalonikiGreece
  8. 8.Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
  9. 9.National University of IrelandGalwayIreland
  10. 10.Department of Neuropsychiatry and Psychosomatic MedicineOslo University HospitalOsloNorway
  11. 11.MRC Unit of Anxiety DisordersUniversity of StellenboschCape TownSouth Africa
  12. 12.Department of PsychiatryFederal University of Rio de JaneiroRio de JaneiroBrazil

Personalised recommendations