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Executive summary of the report by the WPA section on pharmacopsychiatry on general and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders

Abstract

Current gold standard in the treatment of depression includes pharmacotherapeutic and psychotherapeutic strategies together with social support. Due to the actually discussed controversies concerning the differential efficacy of antidepressants, a contribution to a comprehensive clarification seems to be necessary to avert further deterioration and uncertainty from patients, relatives, and their treating psychiatrists and general practitioners. Both efficacy and clinical effectiveness of antidepressants in the treatment of depressive disorders can be confirmed. Clinically meaningful antidepressant treatment effects were confirmed in different types of studies. Methodological issues of randomized controlled studies, meta-analyses, and effectiveness studies will be discussed. Furthermore, actual data about the differential efficacy and effectiveness of antidepressants with distinct pharmacodynamic properties and about outcome differences in studies using antidepressants and/or psychotherapy are discussed. This is followed by a clinically oriented depiction—the differential clinical effectiveness of different pharmacodynamic modes of action of antidepressants in different subtypes of depressive disorders. It can be summarized that the spectrum of different antidepressant treatments has broadened during the last decades. The efficacy and clinical effectiveness of antidepressants is statistically significant and clinically relevant and proven repeatedly. For further optimizing antidepressant treatment plans, clearly structured treatment algorithms and the implementation of psychotherapy seem to be useful. A modern individualized antidepressant treatment in most cases is a well-tolerated and efficacious tool to minimize the negative impact of the otherwise devastating and life-threatening outcome of depressive disorders.

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Conflict of interest

T.C. Baghai accepted paid speaking engagements and acted as a consultant for Astra-Zeneca, Glaxo-Smith-Kline, Janssen-Cilag, Organon, Pfizer and Servier. M. Bauer has received Grant/Research Support from The Stanley Medical Research Institute, NARSAD and the European Commission (FP7). He is a consultant for AstraZeneca, Lilly, Servier, Lundbeck, Bristol-Myers Squibb and Otsuka and has received Speaker Honoraria from AstraZeneca, Lilly, GlaxoSmithKline, Lundbeck, GlaxoSmithKline, Bristol-Myers Squibb and Otsuka. D. Baldwin holds or has held grants from Cephalon, GlaxoSmithKline, Lilly, Lundbeck, Pharmacia and Wyeth; has received honoraria from AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Lilly, Lundbeck, Pharmacia, Pierre Fabre, Pfizer, Servier and Wyeth; and has served on advisory boards for AstraZeneca, GlaxoSmithKline, Grunenthal, Lilly, Lundbeck, Organon, Pierre Fabre, Pfizer and Servier. P. Blier received honoraria for speaking engagements, advisory boards, and/or investigator-initiated grants from Angelini, Astra-Zeneca, Bristol Myers Squibb, Eli Lilly, Euthymics, Janssen, Labopharm, Lundbeck, Merck, Organon, Pfizer, Pierre Fabre, Schering-Plough, Servier, Takeda, Wyeth. G.M.Goodwin holds or has held grants from Bailly Thomas charity, Medical Research Council, NIHR, Servier; has received honoraria from AstraZeneca, BMS, Lundbeck, Sanofi-Aventis, Servier, holds shares in P1vital ltd; has served on advisory boards for AstraZeneca, BMS, Boehringer Ingelheim, Cephalon, Janssen-Cilag, Lilly, Lundbeck, P1Vital, Servier, Shering Plough, Wyeth and acted as an expert witness for Lilly and Servier. K.N. Fountoulakis has received grant/research support from Eli Lilly, Bristol-Myers Squibb, and Servier; has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb and Servier, Janssen, and has given lectures for AstraZeneca, Eli Lily, Janssen, Servier, and Bristol-Myers Suibb. S. Kasper has received grant/research support from Eli Lilly, Lundbeck, Bristol-Myers Squibb, GlaxoSmithKline, Organon, Sepracor and Servier; has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, Lundbeck, Pfizer, Organon, Schwabe, Sepracor, Servier, Janssen, and Novartis; and has served on speakers’ bureaus for AstraZeneca, Eli Lily, Lundbeck, Schwabe, Sepracor, Servier, Pierre Fabre, and Janssen. D. J. Stein has received research grants and/or consultancy honoraria from Abbott, Astrazeneca, Eli-Lilly, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Takeda, Tikvah, and Wyeth. H.-J. Möller has received grant/research support, is member of advisory boards, or has served as a speaker for AstraZeneca, Bristol-Myers Squibb, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, Merck, Novartis, Organon, Pfizer, Sanofi-Aventis, Schering-Plough, Schwabe, Sepracor, Servier and Wyeth. B.E. Leonard, U. Malt and M. Versiani had no conflicts of interest to declare.

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Correspondence to Thomas C. Baghai.

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This study is conducted for the Section of Pharmacopsychiatry, World Psychiatric Association, Altamura C, Andreassen OA, Aarsland D, Baghai TC, Baldwin DS, Baron D, Bauer M, Belmaker RH, Blier P, Boyer P, Bunney WE, Burrows G, Fleischhacker W, Flores D, Fountoulakis KN, Gattaz WF, Goodwin G, Heinze G, Hindmarch I, Hoschl C, Kasper S, Sorensen PK, Langer SZ, Leonard B, Lopez-Ibor JJ, Malt U (co-chair), Millet B, Möller HJ (chair), Monti J, Müller-Oerlinghausen B, Okasha A, Olie JP, Paykel ES, Racagni G, Renshaw P, Rosenberg R, Rutz W, Saletu B, Sedvall G, Singh B (secretary), Stein DJ, Tandon R, Versiani M, Vieta E, Wegener G, Zohar J.

This article is an executive summary of Baghai TC, Blier P, Baldwin DS, Bauer M, Goodwin GM, Fountoulakis KF, Kasper S, Leonard BE, Malt UF, Stein DJ, Versiani M, and Möller HJ for the Section of Pharmacopsychiatry, World Psychiatric Association (2011), General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA section on pharmacopsychiatry. Eur Arch Psychiatry Clin Neurosci 261(Suppl 3). doi:10.1007/s00406-011-0259-6.

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Baghai, T.C., Blier, P., Baldwin, D.S. et al. Executive summary of the report by the WPA section on pharmacopsychiatry on general and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders. Eur Arch Psychiatry Clin Neurosci 262, 13–22 (2012). https://doi.org/10.1007/s00406-011-0274-7

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Keywords

  • Antidepressant treatments
  • Depression
  • Pharmacological treatments
  • Psychotherapy