Der Nervenarzt

, Volume 78, Issue 9, pp 1014–1027

Probleme der „evidence-based medicine“ in der Psychopharmakotherapie: Problematik der Evidenzgraduierung und der Evidenzbasierung komplexer klinischer Entscheidungsprozesse

xxx

Zusammenfassung

Die Psychopharmakotherapie soll, analog zu anderen Bereichen der therapeutischen Medizin, im Sinne der Evidenzbasierung reglementiert werden. Das ist prinzipiell eine sinnvolle Entwicklung, die sich vorteilhaft auf die Routineversorgung auswirken wird. Allerdings dürfen die damit zusammenhängenden Probleme nicht übersehen werden. Ein wichtiges Problem ist die unterschiedliche Definition von Evidenzgraden. Werden placebokontrollierte Studien dabei zu einseitig priorisiert, so entfernt sich die Evidenz zu sehr von den Gegebenheiten des klinischen Alltags. Andererseits führt die Beschränkung auf Vergleichsuntersuchungen gegen Standardpräparate ohne Placebokontrolle möglicherweise zu Fehlschlüssen über die Wirksamkeit. Die Bevorzugung metaanalytischer Ergebnisse anstelle der Fokussierung auf relevante Einzelstudien führt zu einer dem Zulassungsverfahren entgegengesetzten Entscheidungslogik.

Wegen inhärenter methodischer Probleme des metaanalytischen Ansatzes, sollte im Sinne einer komplementären Sichtweise das narrative systematische Review seine traditionelle Bedeutung behalten. Ansätze zur Psychopharmakotherapie im Sinne der evidenzbasierten Medizin zu regeln, stoßen umso mehr an die Grenzen, je komplexer die klinische Situation und die diesbezügliche Entscheidungslogik ist. Auch in Zeiten der evidenzbasierten Medizin ist weiterhin ein Großteil komplexer klinischer Entscheidungen in der Psychopharmakotherapie mehr auf den Konsens über klinische Erfahrungen und Traditionen gestützt als auf eine entsprechende empirische Datenbasis.

Schlüsselwörter

Evidenzbasierung Evidenzgraduierung Psychopharmakotherapie Leitlinien 

Problems of evidence-based medicine in psychopharmacotherapy: problems of evidence grading and of the evidence basis for complex clinical decision making

Summary

Psychopharmacotherapy should now be regulated in the sense of evidence based medicine, as is the case in other areas of therapeutic medicine. In general, this is a meaningful development which will have a positive impact on routine health care. However, related problems should not be ignored. One important problem is the different definition of degrees of evidence. If placebo-controlled studies are prioritized, evidence deviates too much from the conditions of routine clinical care. However, the restriction to active comparative trials could lead to false conclusions about efficacy. In addition, if the focus is placed on the results of meta-analyses instead of considering relevant single studies, the result is a decision making logic contrary to that of the licensing process.

Due to inherent methodological problems of the meta-analytical approach, the narrative, systematic review should retain its traditional importance and be used to provide a complementary view. Attempts to regulate psychopharmacotherapy in the sense of evidence based medicine come closer to their limits the more complex the clinical situation and the respective decision making logic are. Even in times of evidence based medicine, a large part of complex clinical decision making in psychopharmacotherapy still relies more on a consensus about clinical experience and traditions than on relevant empirical databases.

Keywords

Evidence based Evidence rating Psychopharmacotherapy Guidelines 

Literatur

  1. 1.
    Adli M, Bauer M, Rush AJ (2006) Algorithms and collaborative-care systems for depression: are they effective and why? A systematic review. Biol Psychiatry 59: 1029–1038PubMedCrossRefGoogle Scholar
  2. 2.
    Adli M, Rush J, Möller HJ, Bauer M (2003) Algorithms for optimizing the treatment of depression: making the right decision at the right time. Pharmacopsychiatry (Suppl 3) 36: S222–S229Google Scholar
  3. 3.
    Altshuler L, Suppes T, Black D et al. (2003) Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. Am J Psychiatry 160: 1252–1262PubMedCrossRefGoogle Scholar
  4. 4.
    American Psychiatric Association. APA Guideline Development Process. http://www.psych org/psych_pract/treatg/pg/prac_guide cfm 2006Google Scholar
  5. 5.
    Antes G (2004) The evidence base of clinical practice guidelines, health technology assessments and patient information as a basis for clinical decision-making. Z Ärztl Fortbild Qualitätssich 98: 180–184PubMedGoogle Scholar
  6. 6.
    Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. Deutsches Instrument zur methodischen Leitlinien-Bewertung (DELBI). www delbi de 2006Google Scholar
  7. 7.
    Atkins D, Best D, Briss PA et al. (2004) Grading quality of evidence and strength of recommendations. BMJ 19: 1490Google Scholar
  8. 8.
    Baldwin D, Broich K, Fritze J et al. (2003) Placebo-controlled studies in depression: necessary, ethical and feasible. Eur Arch Psychiatry Clin Neurosci 253: 22–28PubMedCrossRefGoogle Scholar
  9. 9.
    Bandelow B, Zohar J, Hollander E et al., WFSBP Task Force on Treatment Guidelines for Anxiety O-CaPSD (2003) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry 3: 171–199CrossRefGoogle Scholar
  10. 10.
    Bauer M, Whybrow PC, Angst J (2002) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, Part 2: Maintenance treatment of major depressive disorder and treatment of chronic depressive disorders and subthreshold depressions. World J Biol Psychiatry 3: 69–86PubMedGoogle Scholar
  11. 11.
    Bauer M, Whybrow PC, Angst J et al., WFSBP Task Force on Treatment Guidelines for Unipolar Depressive Disorders (2002) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, Part 1: Acute and continuation treatment of major depressive disorder. World J Biol Psychiatry 3: 5–43PubMedGoogle Scholar
  12. 12.
    Bottlender R, Rudolf D, Jager M et al. (2002) Are bipolar I depressive patients less responsive to treatment with antidepressants than unipolar depressive patients? Results from a case control study. Eur Psychiatry 17: 200–205PubMedCrossRefGoogle Scholar
  13. 13.
    Bottlender R, Rudolf D, Strauss A, Moller HJ (1998) Antidepressant-associated maniform states in acute treatment of patients with bipolar-I depression. Eur Psychiatry 248: 296–300Google Scholar
  14. 14.
    Boyd CM, Darer J, Boult C et al. (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294: 716–724PubMedCrossRefGoogle Scholar
  15. 15.
    Campbell M, Fitzpatrick R, Haines A et al. (2000) Framework for design and evaluation of complex interventions to improve health. BMJ 321: 694–696PubMedCrossRefGoogle Scholar
  16. 16.
    Carpenter WT (2001) Evidence-based treatment for first-episode schizophrenia? Am J Psychiatry 158: 1771–1773PubMedCrossRefGoogle Scholar
  17. 17.
    Cartabellotta A, Minella C, Bevilacqua L, Caltagirone P (1998) Evidence-based medicine. 3. Systematic reviews: a tool for clinical practice, permanent education and health policy decisions. Italian Group on Evidence-Based Medicine-GIMBE. Recenti Prog Med 89: 329–337PubMedGoogle Scholar
  18. 18.
    Cartabellotta A, Montalto G, Notarbartolo A (1998) Evidence-based medicine. How to use biomedical literature to solve clinical problems. Italian Group on Evidence-Based Medicine-GIMBE. Minerva Med 89: 105–115PubMedGoogle Scholar
  19. 19.
    Clark W, Mucklow J (1998) Gathering and weighing the evidence. In: Panton R, Chapman S (eds) Medicines Management. BMJ Books and Pharmaceutical Press, London, pp 59–74Google Scholar
  20. 20.
    Committee for Proprietary Medicinal Products (CPMP) (2002) Note for guidance on clinical investigation of medicinal products in the treatment of depression. http://www.emea eu int 2002Google Scholar
  21. 21.
    Craig JC, Irwig LM, Stockler MR (2001) Evidence-based medicine:useful tools for decision making. MJA 174: 248–253PubMedGoogle Scholar
  22. 22.
    Czekalla J (2006) Kritische Bewertung von Studien und Metaanalysen. Ein Fortbildungsartikel über die wichtigsten Validitätskriterien der Evidence-based Medicine. Psychopharmakotherapie 13: 224–230Google Scholar
  23. 23.
    Eccles M, Grimshaw J, Campbell M, Ramsay C (2003) Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care 12: 47–52PubMedCrossRefGoogle Scholar
  24. 24.
    Falkai P, Wobrock T, Lieberman J et al. (2005) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, Part 1: acute treatment of schizophrenia. World J Biol Psychiatry 6: 132–191PubMedCrossRefGoogle Scholar
  25. 25.
    Falkai P, Wobrock T, Lieberman J et al. (2006) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: long-term treatment of schizophrenia. World J Biol Psychiatry 7: 5–40PubMedCrossRefGoogle Scholar
  26. 26.
    Fava M, Rush AJ, Trivedi MH et al. (2003) Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatr Clin North Am 26: 457–494PubMedCrossRefGoogle Scholar
  27. 27.
    Fava M, Rush AJ, Wisniewski SR et al. (2006) A comparison of mirtazapine and nortriptyline following two consecutive failed medication treatments for depressed outpatients: a STAR*D report. Am J Psychiatry 163: 1161–1172PubMedCrossRefGoogle Scholar
  28. 28.
    Ferreira PH (2002) Effect of applying different „levels of evidence“ criteria on conclusions of Cochrane reviews of interventions for low back pain. J Clin Epidemiol 55: 1126–1129PubMedCrossRefGoogle Scholar
  29. 29.
    Fritze J, Aldenhoff J, Bergmann F et al. (2007) Hinweise der AkdÄ und KBV zu Quetiapin und anderen modernen Antipsychotika: Richtigstellung der DGPPN. Psychoneuro 33: 31–32CrossRefGoogle Scholar
  30. 30.
    Fritze J, Möller HJ (2001) Design of clinical trials of antidepressants. Should a placebo control arm be included? CNS Drugs 15: 755–764PubMedCrossRefGoogle Scholar
  31. 31.
    Gaebel W (1996) Leitfaden zur Qualitätsbeurteilung in Psychiatrischen Kliniken. Stellungnahme für die DGPPN aus Sicht des Referates „Qualitätssicherung“. Nervenarzt 67: 968–970PubMedGoogle Scholar
  32. 32.
    Gaebel W, Falkai P (1998) Praxisleitlinien in Psychiatrie und Psychotherapie: Behandlungsleitlinie Schizophrenie. Steinkopff, DarmstadtGoogle Scholar
  33. 33.
    Gaebel W, Falkai P (2003) DGPPN-Referat Qualitätssicherung und Leitlinien. Aktueller Stand und Perspektiven der Leitlinienentwicklung. Nervenarzt 74: 94–96PubMedCrossRefGoogle Scholar
  34. 34.
    Gaebel W, Falkai P, Weinmann S, Wobrock T (2006) S3-Praxisleitlinien in Psychiatrie und Psychotherapie. Band 1: Behandlungsleitlinie Schizophrenie. Steinkopff, DarmstadtGoogle Scholar
  35. 35.
    Geddes J et al. (2006) Metaanalysis of lamotrigine studies on the acute treatment of bipolar disorder. Poster presented at the ISBD Regional Meeting, 2–4 August 2006, EdinburghGoogle Scholar
  36. 36.
    Gerson S, Belin TR, Kaufman A et al. (1999) Pharmacological and psychological treatments for depressed older patients: a meta-analysis and overview of recent findings. Harv Rev Psychiatry 7: 1–28PubMedCrossRefGoogle Scholar
  37. 37.
    Gijsman HJ, Geddes JR, Rendell JM et al. (2004) Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry 161: 1537–1547PubMedCrossRefGoogle Scholar
  38. 38.
    Gonzalez DD (2001) From evidence-based medicine to medicine-based evidence. An Esp Pediatr 55: 429–439Google Scholar
  39. 39.
    Gray G (2003) Concise guide to evidence-based psychiatry. American Psychiatric Publishing, WashingtonGoogle Scholar
  40. 40.
    Grell L (2006) Ist der Beschluss des Bundesverfasssungsgerichts der Abschied von der evidenzbasierten Medizin? MMW-Fortschritte der Medizin 148: 103–106Google Scholar
  41. 41.
    Grimshaw J, Eccles M, Thomas R et al. (2006) Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966–1998. J Gen Intern Med (Suppl 2) 21: S14–S20Google Scholar
  42. 42.
    Grimshaw JM, Thomas RE, MacLennan G et al. (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 8: iii-72PubMedGoogle Scholar
  43. 43.
    Grunze H, Kasper S, Goodwin G et al. (2002) World Federation of Societies of Biological Psychiary (WFSBP) guidelines for biological treatment of bipolar disorders, Part I: Treatment of bipolar depression. World J Biol Psychiatry 3: 115–124PubMedCrossRefGoogle Scholar
  44. 44.
    Grunze H, Kasper S, Goodwin G et al. (2003) The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders, Part II: Treatment of mania. World J Biol Psychiatry 4: 5–13PubMedCrossRefGoogle Scholar
  45. 45.
    Grunze H, Kasper S, Goodwin G et al. (2004) The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders, Part III: Maintenance treatment. World J Biol Psychiatry 5: 120–135PubMedCrossRefGoogle Scholar
  46. 46.
    Guyatt G, Gutterman D, Baumann MH et al. (2006) Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest 129: 174–181PubMedCrossRefGoogle Scholar
  47. 47.
    Harter M, Bermejo I, Schneider F et al. (2003) Umfassendes ambulantes Qualitätsmanagment in der Versorgung depressiver Patienten. Z Arztl Fortbild Qualitatssich (Suppl 4) 97: 9–15Google Scholar
  48. 48.
    Heerdink ER, Stolker JJ, Meijer WEE et al. (2004) Need for medicine-based-evidence in pharmacotherapy. Br J Psychiatry 184: 452–456PubMedCrossRefGoogle Scholar
  49. 49.
    Hegerl U, Plattner A, Moller HJ (2004) Should combined pharmaco- and psychotherapy be offered to depressed patients? A qualitative review of randomized clinical trials from the 1990 s. Eur Arch Psychiatry Clin Neurosci 254: 99–107PubMedCrossRefGoogle Scholar
  50. 50.
    Helmchen H (2002) Evidenz der Evidenzbasierten Medizin? Der Nervenarzt 73: 1–2PubMedCrossRefGoogle Scholar
  51. 51.
    Hirschfeld RMA, Montgomery SA, Aguglia E et al. (2002) Partial response and nonresponse to antidepressant therapy: current approaches and treatment options. J Clin Psychiatry 63: 826–837PubMedGoogle Scholar
  52. 52.
    Höffler D, Lasek R, Tiaden JD (2001) Handlungsleitlinie Demenz Arzneimittelkommission der Deutschen Ärzteschaft, Arzneiverordnung in der Praxis. Arzneiverordnung in der Praxis SonderheftGoogle Scholar
  53. 53.
    Hunink MMG (2004) Does evidence based medicine do more good than harm? BMJ 329: 1051CrossRefGoogle Scholar
  54. 54.
    Jadad AR, Phil D, Cook DJ (1998) Methodology and Reports of Systematic Reviews and Meta-analyses-Acomparison of cochrane reviews with articles published in paper-based Journals. JAMA 280: 278–280PubMedCrossRefGoogle Scholar
  55. 55.
    Jorgensen WA, Hilden J, Gotzsche C (2006) Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review. BMJ EPubGoogle Scholar
  56. 56.
    Kane JM, Honigfeld G, Singer J, Meltzer H (1988) Clozapine in treatment-resistant schizophrenics. Psychopharmacol Bull 24: 62–67PubMedGoogle Scholar
  57. 57.
    Kasper S, Möller HJ (2007) Psychopharmakotherapie: klinisch-empirische Grundlagen. In: Möller HJ, Laux G, Kapfhammer HP (Hrsg) Psychiatrie und Psychotherapie, 3. Aufl. Springer, Berlin Heidelberg (in Druck)Google Scholar
  58. 58.
    Kawamura T, Tamakoshi A, Wakai K, Ohno Y (1999) Evidence-based medicine and ‚The Cochrane Collaboration’. Nippon Koshu Eisei Zasshi 46: 498–506PubMedGoogle Scholar
  59. 59.
    Khan KS, Kunz R, Kleijnen J, Antes G (2004) Systematische Übersichten und Meta-Analysen. Ein Handbuch für Ärzte in Klinik und Praxis sowie Experten im Gesundheitswesen. Springer, BerlinGoogle Scholar
  60. 60.
    Klein DF (2000) Flawed meta-analyses comparing psychotherapy with pharmacotherapy. Am J Psychiatry 157: 1204–1211PubMedCrossRefGoogle Scholar
  61. 61.
    Koller M, Lorenz W, Abel U (2006) Methodenvielfalt in der klinischen Forschung. MMW-Fortschritte der Medizin 148: 85–91Google Scholar
  62. 62.
    Kopp I, Encke A, Hartig S et al. (2005) Zur Empirie hochwertiger Leitlinien im System der Arbeitsgemeinschaft Wissenschaftlicher Medizinischer Fachgesellschaften (AWMF): Gibt es sie und wie viele? Deutsche Gesellschaft für Chirurgie – Mitteilungen 1: 21–29Google Scholar
  63. 63.
    Kunz R, Ollenschläger G, Raspe H et al. (2000) Lehrbuch Evidenzbasierte Medizin in Klinik und Praxis. Dt Ärzte-Verlag, KölnGoogle Scholar
  64. 64.
    Laux G (2007) Guidelines – Leitlinen – Algorithmen. Ein aktuelles klinisches Resümee. Psychiatr Prax 34: S148–S150CrossRefGoogle Scholar
  65. 65.
    Letmaier M, Schreinzer D, Thierry N et al. (2004) Medikamentöse Behandlung akuter Manien. Eine retrospektive Datenanalyse stationärer Patienten von 1997 bis 1999. Der Nervenarzt 75: 249–257PubMedCrossRefGoogle Scholar
  66. 66.
    Lieberman JA, Greenhouse J, Hamer RM et al. (2005) Comparing the effects of antidepressants: consensus guidelines for evaluating quantitative reviews of antidepressant efficacy. Neuropsychopharmacology 30: 445–460PubMedCrossRefGoogle Scholar
  67. 67.
    Lieberman JA, Stroup TS, McEvoy JP et al. (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353: 1209–1223PubMedCrossRefGoogle Scholar
  68. 68.
    Linden M (2002) Verhaltenstherapie: theoretische und empirische Grundlagen sowie klinische Anwendungsprinzipien. In: Möller HJ, Laux G, Kapfhammer HP (Hrsg) Psychiatrie & Psychotherapie. Springer, Berlin Heidelberg New York, S 681–710Google Scholar
  69. 69.
    Lockwood DNJ, Armstrong M, Grant AD (2004) Integrating evidence based medicine into routine clinical practice: seven years‘ experience at the hospital for tropical diseases, London. BMJ 329: 1020–1023PubMedCrossRefGoogle Scholar
  70. 70.
    Lohr KN (2004) Rating the strength of scientific evidence: relevance for quality improvement programs. Int J Qual Health Care 16: 9–18PubMedCrossRefGoogle Scholar
  71. 71.
    Manser R, Walters EH (2001) What is evidence-based medicine and the role of the systematic review: the revolution coming your way. Monaldi Arch Chest Dis 56: 33–38PubMedGoogle Scholar
  72. 72.
    Moher D, Cook DJ, Eastwood S et al. (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 354: 1896–1900PubMedCrossRefGoogle Scholar
  73. 73.
    Möller HJ, Laux G, Naber D (2005) Kosten und Effekte von Risperidon in Depotform. Vergleich mit oralen Atypika und konventionellen Depotformulierungen in der Therapie von Schizophreniepatienten in Deutschland. Psychopharmakotherapie 12: 183–192Google Scholar
  74. 74.
    Möller HJ (2000) State of the art of drug treatment of schizophrenia and the future position of the novel/atypical antipsychotics. World J Biol Psychiatry 1: 204–214PubMedGoogle Scholar
  75. 75.
    Möller HJ (2004) Therapieresistenz auf Antidepressiva. Definition, Häufigkeit, Prädiktoren und Interventionsmöglichkeiten. Der Nervenarzt 5: 499–512CrossRefGoogle Scholar
  76. 76.
    Möller HJ (2007) Methodik empirischer Forschung und evidenz-basierter Medizin in der Psychiatrie. In: Möller HJ, Laux G, Kapfhammer HP (Hrsg) Psychiatrie und Psychotherapie. 3. Aufl. Springer Verlag, Berlin Heidelberg (in Druck)Google Scholar
  77. 77.
    Möller HJ, Fuger J, Kasper S (1993) Statistische Metaanalyse der Wirksamkeit neuerer Antidepressiva. In: Antidepressiva und Phasenprophylaktika. Springer, Wien, S 252–256Google Scholar
  78. 78.
    Möller HJ, Gaebel W, Naber D, Rüther E (2006) Atypische Antipsychotika in Deutschland. Eine Bestandsaufnahme. Psychopharmakotherapie 13: 164–168Google Scholar
  79. 79.
    Möller HJ, Grunze H (2000) Have some guidelines for the treatment of acute bipolar depression gone too far in the restriction of antidepressants? Eur Arch Psychiatry Clin Neurosci 250: 57–68PubMedCrossRefGoogle Scholar
  80. 80.
    Möller HJ, Grunze H, Broich K (2006) Do recent efficacy data on the drug treatment of acute bipolar depression support the position that drugs other than antidepressants are the treatment of choice? A conceptual review. Eur Arch Psychiatry Clin Neurosci 256: 1–16PubMedCrossRefGoogle Scholar
  81. 81.
    Nierenberg AA, Fava M, Trivedi MH et al. (2006) A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report. Am J Psychiatry 163: 1519–1530PubMedCrossRefGoogle Scholar
  82. 82.
    Ollenschlager G, Berenbeck C, Low A et al. (2002) [The National Program for disease management – guidelines under the auspices of the German Medical Association-a method report]. Z Arztl Fortbild Qualitatssich 96: 545–548PubMedGoogle Scholar
  83. 83.
    Ollenschlager G, Helou A, Kostovic-Cilic L et al. (1998) Checklist for methodological quality of guidelines. A contribution to quality promotion of medical guidelines. Z Arztl Fortbild Qualitatssich 92: 191–194PubMedGoogle Scholar
  84. 84.
    Pfaff H (2005) Konzept und Methodik der Versorgungsforschung. Die Psychiatrie 2: 101–106Google Scholar
  85. 85.
    Phillips B, Ball C, Sackett D et al. (2001) Oxford Centre for Evidence-based Medicine Levels of Evidence. Levels of evidence and grades of recommendation. www.cebm net/levels_of_evidence asp 2001Google Scholar
  86. 86.
    Pilling S, Price K (2006) Developing and implementing clinical guidelines: lessons from the NICE schizophrenia guideline. Epidemiol Psichiatr Soc 15: 109–116PubMedGoogle Scholar
  87. 87.
    Rush AJ, Trivedi MH, Wisniewski SR et al. (2006) Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med 354: 1231–1242PubMedCrossRefGoogle Scholar
  88. 88.
    Sackett DL (2000) Evidence-Based Medicine: How to practice and teach EBM. Churchill Livingstone, New YorkGoogle Scholar
  89. 89.
    Sackett DL, Richardson S, Rosenberg WS et al. (1999) Evidenzbasierte Medizin. Zuckschwerdt, MünchenGoogle Scholar
  90. 90.
    Schmacke N (2006) Evidenzbasierte Medizin und Psychotherapie: die Frage nach den angemessenen Erkenntnismethoden. Psychother Psychosom Med Psychol 56: 202–209PubMedCrossRefGoogle Scholar
  91. 91.
    Schöchlin C, Möller HJ, Engel RR (2002) Meta-Analysen von Antidepressiva-Studien. In: Riederer P, Laux G, Pöldinger W (Hrsg) Neuro-Psychopharmaka, Bd 3, 2. Aufl. Springer, Wien New York, S 349–363Google Scholar
  92. 92.
    Sheiner LB (1997) Learning versus confirming in clinical drug development. Clin Pharmacol Ther 61: 275–291PubMedCrossRefGoogle Scholar
  93. 93.
    Trivedi MH, Fava M, Wisniewski SR et al. (2006) Medication augmentation after the failure of SSRIs for depression. N Engl J Med 354: 1243–1252PubMedCrossRefGoogle Scholar
  94. 94.
    Trivedi MH, Rush AJ, Wisniewski SR et al. (2006) Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 163: 28–40PubMedCrossRefGoogle Scholar
  95. 95.
    Wampold BE, Minami T, Baskin TW, Callen TS (2002) A meta-(re)analysis of the effects of cognitive therapy versus ‚other therapies‘ for depression. J Affect Disord 68: 159–165PubMedCrossRefGoogle Scholar
  96. 96.
    Weinmann S (2006) Evidenzbasierte Psychiatry. Methoden und Anwendungen. Kohlhammer, StuttgartGoogle Scholar
  97. 97.
    Lehmann AF, Steinwachs DM (1998) Translating research into practice: the Schizophrenia Patient Outcome Research Team (PORT) treatment recommendations. Schizophr Bull 24: 1–10Google Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Psychiatrische Klinik der Ludwig-Maximilians-UniversitätMünchenDeutschland

Personalised recommendations