CNS Drugs

, Volume 13, Issue 5, pp 365–383 | Cite as

Suboptimal Use of Antidepressants in the Treatment of Depression

Review Article


Depression is a common and serious mental illness which is treated mainly in primary care settings. The most common treatment modality is antidepressant medication. Controlled clinical trials have found antidepressants to be effective in the treatment of the acute symptoms of depression and in the prevention of relapse and recurrence of the disorder.

To be effective, antidepressants need to be taken in sufficient doses for adequate periods of time. Many attempts have been made to ensure that the treatments available for depression are applied effectively in clinical practice, mainly through the development and promulgation of consensus guidelines. The various guidelines are consistent in recommending that antidepressants be administered at adequate doses both during the acute phase of treatment and for 4 to 6 months after a response is achieved.

However, optimal use of antidepressants appears to be the exception rather than the rule. Patients who are treated with older tricyclic antidepressants (TCAs) rarely receive doses which have clear evidence of efficacy. Patients taking TCAs or newer antidepressants such as the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) commonly stop treatment prematurely. As few as 1 patient in 17 on TCAs, and 1 in 3 on SSRIs, continues treatment at an effective dose for the minimum recommended period of 4 consecutive months.

The patterns of treatment with antidepressants are completely incongruous with the magnitude of burden and risk associated with major depression. This is reflected in evidence of poor outcomes in both the short and longer terms. Failure to treat depression at an early stage contributes to the development of chronic depressive illness. Inadequate doses of antidepressants result in a failure to respond and premature discontinuation increases the risk of relapse; both these patterns of treatment seem to contribute to the development of recurrent depressive episodes.

Despite these findings, suboptimal use of antidepressants in the treatment of depression appears to be universal. It seems that clinicians require clear guidance regarding the crucial importance of recognising depression and initiating effective treatment without delay. They also need information that they regard as credible regarding the vital necessity for patients to receive an effective antidepressant dose for an adequate period of time. There is compelling evidence that this is less likely to be achieved with a TCA than with an SSRI. Given the morbidity and burden caused by depression, centrally coordinated naturalistic studies to investigate the outcomes of suboptimal antidepressant use should be a key priority for government research initiatives.


  1. 1.
    Donoghue JM. Sub-optimal use of tricyclic antidepressants in primary care [editorial]. Acta Psychiatr Scand 1998; 98: 429–31PubMedCrossRefGoogle Scholar
  2. 2.
    Weiller E, Lecrubier Y, Boyer P. Antidepressant use in general practice. Therapie 1996; 51: 429–30PubMedGoogle Scholar
  3. 3.
    Klerman GL, Weissman MM. The course, morbidity, and costs of depression. Arch Gen Psychiatry 1992; 49: 831–4PubMedCrossRefGoogle Scholar
  4. 4.
    Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients: results from the medical outcomes study. JAMA 1989; 262: 914–9PubMedCrossRefGoogle Scholar
  5. 5.
    Hays RD, Wells KB, Sherbourne CD, et al. Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Arch Gen Psychiatry 1995; 52: 11–9PubMedCrossRefGoogle Scholar
  6. 6.
    Simon GE, VonKorff M, Barlow W. Health care costs of primary care patients with recognised depression. Arch Gen Psychiatry 1995; 52: 850–6PubMedCrossRefGoogle Scholar
  7. 7.
    Kind P, Sorensen J. The costs of depression. Int Clin Psychopharmacology 1993; 7: 191–5CrossRefGoogle Scholar
  8. 8.
    Brugha TS. Depression undertreatment: lost cohorts, lost opportunities? Psycholog Med 1995; 25: 3–6CrossRefGoogle Scholar
  9. 9.
    Pharmacotherapy of depressive disorders: a consensus statement. WHO Mental Health Collaborating Centres. J Affect Disord 1989; 17(2): 197–8CrossRefGoogle Scholar
  10. 10.
    Paykel ES, Priest RG. Recognition and management of depression in general practice: consensus statement. BMJ 1992; 305: 1198–202PubMedCrossRefGoogle Scholar
  11. 11.
    Montgomery SA, Bebbington P, Cowen P, et al. Guidelines for treating depressive illness with antidepressants. J Psychopharmacol 1993; 7: 19–23PubMedGoogle Scholar
  12. 12.
    Clinical Resource and Audit Group. Depressive illness: a critical review of current practice and the way ahead. Consensus statement. Edinburgh: The Scottish Office, National Health Service in Scotland, 1993Google Scholar
  13. 13.
    Depression Guideline Panel, Agency for Health Care Policy Research Treatment of Major Depression. Clinical practice guideline. No. 5, Vol. 2. Rockville (MD): US Department of Health and Human Services, 1993 (AHCPR Publication No. 93-0550, 1993. 20)Google Scholar
  14. 14.
    The treatment of depression in primary care: which treatments are effective in the management of depression in primary care? Eff Health Care 1993; 5: 1-12Google Scholar
  15. 15.
    Selecting an antidepressant. MeReC Bulletin 1995; 6 (I): 1-4Google Scholar
  16. 16.
    Karasu TB, Docherty JP, Gelenberg A, et al. Practice guideline for major depressive disorder in adults. In: Practice guidelines. Washington, DC: American Psychiatric Association, 1996: 83–127Google Scholar
  17. 17.
    Crismon ML, Trivedi M, Pigott TA, et al. The Texas medication algorithm project: report of the Texas consensus conference panel on medication treatment of major depressive disorder. J Clin Psychiatry 1999; 60: 142–56PubMedCrossRefGoogle Scholar
  18. 18.
    Song F, Freemantle N, Sheldon TA, et al. Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. BMJ 1993; 306: 683–7PubMedCrossRefGoogle Scholar
  19. 19.
    Anderson IM, Tomenson BM. The efficacy of selective serotonin re-uptake inhibitors in depression: a meta-analysis of studies against tricyclic antidepressants. J Psychopharmacol 1994; 8: 238–49PubMedCrossRefGoogle Scholar
  20. 20.
    Montgomery SA, Henry J, McDonald G, et al. Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. Int Clin Psychopharmacol 1994; 9: 47–53PubMedCrossRefGoogle Scholar
  21. 21.
    Hotopf M, Hardy R, Lewis G. Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity. Br J Psychiatry 1997; 170: 120–7PubMedCrossRefGoogle Scholar
  22. 22.
    Kendrick T. Prescribing antidepressants in general practice: watchful waiting for minor depression, full dose treatment for major depression. BMJ 1996; 313: 829–30PubMedCrossRefGoogle Scholar
  23. 23.
    Paykel ES, Hollyman JA, Freeling P, et al. Predictors of therapeutic benefit from amitriptyline in mild depression: a general practice placebo-controlled trial. J Affect Disord 1988; 14: 83–95PubMedCrossRefGoogle Scholar
  24. 24.
    Thompson C, Thompson CM. The prescribing of antidepressants in general practice: II.A placebo-controlled trial of low-dose dothiepin. Hum Psychopharmacol 1989; 4: 191–204CrossRefGoogle Scholar
  25. 25.
    Tyrer P, Murphy S, Kingdon D, et al. The Nottingham study of neurotic disorder: comparison of drug and psychological treatments. Lancet 1988; I: 235–40CrossRefGoogle Scholar
  26. 26.
    Bollini P, Pampallona S, Tibaldi G, et al. Effectiveness of antidepressants: meta-analysis of dose-effect relationships in randomised clinical trials. Br J Psychiatry 1999; 174: 297–303PubMedCrossRefGoogle Scholar
  27. 27.
    Thase ME, Sullivan LR. Relapse and recurrence of depression: a practical approach for prevention. CNS Drugs 1995; 4: 261–77CrossRefGoogle Scholar
  28. 28.
    Maj M, Vietro F, Pirozzi R, et al. Pattern of recurrence of illness after recovery of an episode of major depression: a prospective study. Am J Psychiatry 1992; 149: 795–800PubMedGoogle Scholar
  29. 29.
    Melfi CA, Chawla AJ, Croghan TW, et al. The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Arch Gen Psychiatry 1998; 55: 1128–32PubMedCrossRefGoogle Scholar
  30. 30.
    Johnson DAW. Treatment of depression in general practice. BMJ 1973; 1: 18–20CrossRefGoogle Scholar
  31. 31.
    Kotin J, Post RM, Goodwin FK. Drug treatment of depressed patients referred for hospitalisation. Am J Psychiatry 1973; 130: 1139–41PubMedGoogle Scholar
  32. 32.
    Johnson DAW. A study of the use of antidepressant medication in general practice. Br J Psychiatry 1974; 125: 186–92PubMedCrossRefGoogle Scholar
  33. 33.
    Johnson DAW. Depression: treatment compliance in general practice. Acta Psychiatr Scand 1981; 63 Suppl. 290: 447–53CrossRefGoogle Scholar
  34. 34.
    Keller MB, Klerman GL, Lavori PW, et al. Treatment received by depressed patients. J Am Med Assoc 1982; 248: 1848–55CrossRefGoogle Scholar
  35. 35.
    Jick H, Dinan BJ, Hunter JW, et al. Tricyclic antidepressants and convulsions. J Clin Psychopharmacol 1983; 3: 182–5PubMedCrossRefGoogle Scholar
  36. 36.
    Jones L, Simpson D, Brown AC, et al. Prescribing psychotropic drugs in general practice: three year study. BMJ 1984; 289: 1045–8PubMedCrossRefGoogle Scholar
  37. 37.
    Pollock BG, Perel JM. Tricyclic antidepressants: contemporary issues for therapeutic practice. Can J Psychiatry 1989; 34: 609–17PubMedGoogle Scholar
  38. 38.
    Keller MB, Lavori PW, Klerman GL, et al. Low levels and lack of predictors of somatotherapy and psychotherapy received by depressed patients. Arch Gen Psychiatry 1986; 43: 458–66PubMedCrossRefGoogle Scholar
  39. 39.
    Thompson C, Thompson CM. The prescription of antidepressants in general practice: I. A critical review. Hum Psychopharmacol 1989; 4: 91–102CrossRefGoogle Scholar
  40. 40.
    McCombs JS, Nichol MB, Stimmel GL, et al. The cost of antidepressant drug therapy failure: a study of antidepressant use patterns in a medicaid population. J Clin Psychiatry 1990; 51 Suppl. 6: 60–9Google Scholar
  41. 41.
    Katon W, VonKorff M, Lin E, et al. Adequacy and duration of antidepressant treatment in primary care. Med Care 1992; 30: 67–76PubMedCrossRefGoogle Scholar
  42. 42.
    Simon GE, VonKorff M, Wagner EH, et al. Patterns of antidepressant use in community practice. Gen Hosp Psychiatry 1993; 15: 399–408PubMedCrossRefGoogle Scholar
  43. 43.
    Rosholm J-U, Hallas J, Gram LF. Outpatient utilisation of antidepressants: a prescription database analysis. J Affect Disord 1993; 27: 21–8PubMedCrossRefGoogle Scholar
  44. 44.
    Rosholm JU, Gram LF, Damsbo N, et al. Antidepressant treatment in general practice — an interview study. Scand J Prim Care 1995; 13: 281–6CrossRefGoogle Scholar
  45. 45.
    Munizza C, Tibaldi G, Bollini P, et al. Prescription pattern of antidepressants in out-patient psychiatric practice. Psychologic Med 1995; 25: 771–8CrossRefGoogle Scholar
  46. 46.
    Bingefors K, Isacson D, von Knorring L. Antidepressant dose patterns in Swedish clinical practice. Int Clin Psychopharmacol 1997; 12(5): 283–90PubMedCrossRefGoogle Scholar
  47. 47.
    Donoghue JM, Tylee A, Wildgust HJ. Cross sectional database analysis of antidepressant prescribing in general practice in the United Kingdom, 1993–5. BMJ 1996; 313: 861–2PubMedCrossRefGoogle Scholar
  48. 48.
    Matthews K, Eagles JM, Matthews CA. The use of antidepressant drugs in general practice: a questionnaire survey. Euro J Clin Pharmacol 1993; 45: 205–10CrossRefGoogle Scholar
  49. 49.
    Kerr MR Antidepressant prescribing: a comparison between general practitioners and psychistrists. Br J Gen Pract 1994; 44: 275–6PubMedGoogle Scholar
  50. 50.
    Thomson RJ. Antidepressant prescribing among referrals to a community mental health unit in New Zealand. Psychiatr Bull 1994; 18: 461–2CrossRefGoogle Scholar
  51. 51.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980Google Scholar
  52. 52.
    Donoghue JM. The prescribing of antidepressants in general practice: the use of PACT data (brief report). Postgrad Med J 1994; 70 Suppl. 2: S23–S24PubMedGoogle Scholar
  53. 53.
    Wells KB, Katon W, Rogers B, et al. Use of minor tranquillisers and antidepressant medications by depressed outpatients: results from the Medical Outcomes Study. Am J Psychiatry 1994; 151: 694–700PubMedGoogle Scholar
  54. 54.
    Arpino C, Da Cas R, Donini G, et al. The use and misuse of antidepressant drugs in a random sample of the population of Rome, Italy. Acta Psychiatr Scand 1995; 92: 7–9PubMedCrossRefGoogle Scholar
  55. 55.
    Donoghue JM, Tylee A. The treatment of depression: prescribing patterns of antidepressants in primary care in the United Kingdom. Br J Psychiatry 1996; 168: 164–8PubMedCrossRefGoogle Scholar
  56. 56.
    MacDonald TM, McMahon AD, Reid IC, et al. Antidepressant drug use in primary care: a record linkage study in Tayside, Scotland. BMJ 1996; 313: 860–1PubMedCrossRefGoogle Scholar
  57. 57.
    World Health Organization. International classification of diseases. 10th ed. Geneva: World Health Organization, 1992Google Scholar
  58. 58.
    Rouillon F, Blachier C, Dreyfus JP, et al. Etude pharmaco-epidemiologique de la consommation des antidepresseurs en population generale L’encephale Sp 1996; 1: 39–48Google Scholar
  59. 59.
    Gregor KJ, Hylan TR, van Dijk PCM, et al. Outpatient antidepressant utilisation in a Dutch sick fund. Am J Manage Care 1998; 4: 1150–60Google Scholar
  60. 60.
    Isometsa E, Seppala I, Henriksson M, et al. Inadequate dosaging in general practice of tricyclic vs. other antidepressants for depression. Acta Psychiatr Scand 1998; 98: 451–4PubMedCrossRefGoogle Scholar
  61. 61.
    Donoghue J, Katona C, Tylee A. The treatment of depression: antidepressant prescribing for elderly patients in primary care. J Pharm 1998; 260: 500–2Google Scholar
  62. 62.
    Dunn RL, Donoghue JM, Ozminkowski RJ, et al. Longitudinal patterns of antidepressant prescribing in primary care in the UK: comparison with treatment guidelines. J Psychopharmacol 1999; 13(2): 136–43PubMedCrossRefGoogle Scholar
  63. 63.
    Donoghue JM. Selective serotonin re-uptake inhibitor use in primary care: a five year naturalistic study. Clin Drug Invest 1998 Dec; 16(6): 453–62CrossRefGoogle Scholar
  64. 64.
    Tylee A, Gastpar M, Lepine J-P, et al. DEPRES II (Depression Research in European Society II): a patient survey of the symptoms, disability, and current management of depression in the community. DEPRES Steering Committee. Int Clin Psychopharmacol 1999; 14(3): 139–51CrossRefGoogle Scholar
  65. 65.
    Keller MB, Klerman GL, Lavori PW, et al. The persistent risk of chronicity in recurrent episodes of non-bipolar major depressive disorder: a prospective follow-up. Am J Psychiatry 1986; 143: 24–8PubMedGoogle Scholar
  66. 66.
    Kiloh LG, Andrews G, Neilson M. The long-term outcome of depressive illness. Br J Psychiatry 1988; 153: 752–7PubMedCrossRefGoogle Scholar
  67. 67.
    Goethe JW, Szarek BL, Cook WL. A comparison of adequately vs. Inadequately treated depressed patients. J Nerv Ment Dis 1988; 176: 465–70PubMedCrossRefGoogle Scholar
  68. 68.
    Scott J. Chronic depression. Br J Psychiatry 1988; 153: 287–97PubMedCrossRefGoogle Scholar
  69. 69.
    Rutz W, Walinder J, Eberhard G, et al. An educational programme on depressive disorders for general practitioners in Gotland: Background and evaluation. Acta Psychiatr Scand 1989; 79: 19–26PubMedCrossRefGoogle Scholar
  70. 70.
    Bacani-Oropilla T, Lippman SB. Chronic depression: issues in long-term management. Postgrad Med 1989; 85: 171–5PubMedGoogle Scholar
  71. 71.
    Frank E, Kupfer DJ, Perel JM, et al. Three year outcomes for maintenance therapies in recurrent depression. Arch Gen Psychiatry 1990; 47: 1093–9PubMedCrossRefGoogle Scholar
  72. 72.
    Prien RF, Kupfer DJ, Mansky PA, et al. Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Report of the NIMH collaborative study group comparing lithium carbonate, imipramone, and a lithium carbonate-imipramine combination. Arch Gen Psychiatry 1984; 41: 1096–104Google Scholar
  73. 73.
    Thase ME. Relapse and recurrence in umipolar major depression: short-term and long-term approaches. J Clin Psychiatry 1990; 51 Suppl.: 51–7PubMedGoogle Scholar
  74. 74.
    Scott J, Eccleston D. Prediction, treatment and prognosis of chronic primary major depression. Int Clin Psychopharmacol 1991; 6 Suppl. 1:41–9PubMedCrossRefGoogle Scholar
  75. 75.
    Brugha TS, Bebbington PE, MacCarthy B, et al. Antidepressants may not assist recovery in practice: a naturalistic prospective survey. Acta Psychiatr Scand 1992; 86: 5–11PubMedCrossRefGoogle Scholar
  76. 76.
    Mintz J, Mintz LI, Arruda MJ, et al. Treatments of depression and the functional capacity to work. Arch Gen Psychiatry 1992; 49(10): 761–8PubMedCrossRefGoogle Scholar
  77. 77.
    Shea MT, Elkin I, Imber SD, et al. Course of depressive symptoms over follow-up. Arch Gen Psychiatry 1992; 49: 782–7PubMedCrossRefGoogle Scholar
  78. 78.
    Frank E, Kupfer DJ, Perel JM, et al. Comparison of full-dose versus half-dose pharmacotherapy in the maintenance treatment of recurrent depression. J Affect Disord 1993; 27: 139–45PubMedCrossRefGoogle Scholar
  79. 79.
    Isacsson G, Holmgren P, Wassermen D, et al. Use of antidepressants among people committing suicide in Sweden. Br Med J 1994; 308: 506–9CrossRefGoogle Scholar
  80. 80.
    Simon GE, Lin EHB, Katon W, et al. Outcomes of ‘inadequate’ antidepressant treatment. J Gen Intern Med 1995; 10: 663–70PubMedCrossRefGoogle Scholar
  81. 81.
    Schulberg HC, Block MR, Madonia MJ, et al. Treating major depression in primary care practice. Eight month clinical outcomes. Arch Gen Psychiatry 1996; 53: 913–9PubMedCrossRefGoogle Scholar
  82. 82.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987Google Scholar
  83. 83.
    Lave JR, Frank RG, Schulberg HC, et al. Cost-effectiveness of treatments for major depression in primary care practice. Arch Gen Psychiatry 1998; 55: 645–51PubMedCrossRefGoogle Scholar
  84. 84.
    Ali IM. Long-term treatment with antidepressants in primary care. Psychiatr Bull 1998; 22: 15–9CrossRefGoogle Scholar
  85. 85.
    Fish D. What is an effective dose [letter]? BMJ 1997; 314: 826PubMedCrossRefGoogle Scholar
  86. 86.
    Moore MV. More on what is an effective dose [letter]. BMJ 1997; 314: 826PubMedCrossRefGoogle Scholar
  87. 87.
    Tan RS. Low dose tricyclic antidepressants are effective in treating major depression [letter]. BMJ 1997; 314: 827PubMedGoogle Scholar
  88. 88.
    Dodd GK, Berti C. A critical appraisal of a naturalistic study to support cost effective prescribing patterns of selective serotonin reuptake inhibitors in primary care. J Serotonin Res 1997; 3: 169–72Google Scholar
  89. 89.
    Donoghue JM. Response to: a critical appraisal of a naturalistic study to support cost effective prescribing patterns of selective serotonin reuptake inhibitors in primary care. J Serotonin Res 1997; 4: 233–7Google Scholar
  90. 90.
    Hotopf M, Lewis G, Normand C. Putting trials on trial — the costs and consequences of small trials in depression: a systematic review of methodology. J Epidemiol Community Health 1997; 51: 354–8PubMedCrossRefGoogle Scholar
  91. 91.
    Freeman HL, O’Hanlon JF. Acute and subacute effects of antidepressants on performance. J Drug Dev Clin Pract 1995; 7: 7–20Google Scholar
  92. 92.
    Ray WA. Psychotropic drugs and injuries among the elderly: a review. J Clin Psychopharmacol 1992; 12: 386–96PubMedGoogle Scholar
  93. 93.
    Henry JA, Alexander CA, Sener EK. Relative mortality from overdose of antidepressants. BMJ 1995; 310: 221–4PubMedCrossRefGoogle Scholar
  94. 94.
    Demyttenaere K. Compliance during treatment with antidepressants. J Affect Disord 1997; 43: 27–39PubMedCrossRefGoogle Scholar
  95. 95.
    Freemantle N, House A, Mason J, et al. Economics of treatment of depression [letter]. Br J Psychiatry 1995; 166: 397PubMedCrossRefGoogle Scholar
  96. 96.
    Hotopf M, Lewis G, Normand C. Are SSRIs a cost effective alternative to tricyclics? Br J Psychiatry 1996; 168: 404–9PubMedCrossRefGoogle Scholar
  97. 97.
    Jonsson B, Bebbington PE. What price depression? The cost of depression and the cost-effectiveness of pharmacological treatment. Br J Psychiatry 1994; 164: 665–73PubMedCrossRefGoogle Scholar
  98. 98.
    Le Pen C, Levy E, Ravily J, et al. The cost of treatment dropout in depression. A cost-benefit analysis of fluoxetine vs tricyclics. J Affect Disord 1994; 31: 1–18PubMedCrossRefGoogle Scholar
  99. 99.
    Sclar DA, Robison LM, Skaer TL, et al. Antidepressant pharmacotherapy: economic outcomes in a health maintenance organisation. Clin Ther 1994; 16: 715–30PubMedGoogle Scholar
  100. 100.
    Stewart A. Antidepressant pharmacotherapy: cost comparison of SSRIs and TCAs. BMJ Economics 1994; 7: 67–79Google Scholar
  101. 101.
    Lapierre Y, Bentkover J, Schainbaum S, et al. Direct cost of depression: analysis of treatment costs of paroxetine versus imipramine in Canada. Can J Psychiatry 1995; 40: 370–7PubMedGoogle Scholar
  102. 102.
    Simon G, Wagner E, VonKorff M. Cost-effectiveness comparisons using ‘real world’ randomised trials: the case of new antidepressant drugs. J Clin Epidemiol 1995; 48: 363–73PubMedCrossRefGoogle Scholar
  103. 103.
    Skaer TL, Sclar DA, Robison LM, et al. Economic evaluation of amitriptyline, desipramine, nortriptyline and sertraline in the management of patients with depression. Curr Ther Res 1995; 56: 556–67CrossRefGoogle Scholar
  104. 104.
    Forder J, Kavanagh S, Fenyo A. A comparison of the cost-effectiveness of sertraline versus tricyclic antidepressants in primary care. J Affect Disord 1996; 38: 97–111PubMedCrossRefGoogle Scholar
  105. 105.
    Simon GE, VonKorff M, Heiligenstein JH, et al. Initial antidepressant choice in primary care. J Am Med Assoc 1996; 275: 1897–902CrossRefGoogle Scholar
  106. 106.
    Thompson D, Buesching D, Gregor KJ, et al. Patterns of antidepressant use and their relation to costs of care. Am J Manage Care 1996; 2: 1239–46Google Scholar
  107. 107.
    Donoghue JM. Costs of treating depression: policy should be evidence-based [commentary]. In: Maj M, Sartorius N, editors. Depressive disorders. Vol. 1. Chichester: John Wiley & Sons Ltd, 1999: 459-61 (Evidence and Experience in Psychiatry Series, World Psychiatric Association)Google Scholar
  108. 108.
    Rosenbaum JF, Hylan TR. Costs of depressive disorders: a review. In: Maj M, Sartorius N, editors. Depressive disorders. Vol. 1. Chichester: John Wiley & Sons Ltd, 1999: 401-49 (Evidence and Experience in Psychiatry Series, World Psychiatric Association)Google Scholar

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© Adis International Limited 2000

Authors and Affiliations

  1. 1.PCS HealthLiverpoolEngland
  2. 2.South London & Maudsley NHS TrustLondonEngland

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