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WFSBP Task Force on Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders in Primary Care

University Hospital Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
The World Journal of Biological Psychiatry (Impact Factor: 4.23). 02/2007; 8(2):67-104. DOI: 10.1080/15622970701227829
Source: PubMed

ABSTRACT These practical guidelines for the biological treatment of unipolar depressive disorders in primary care settings were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). They embody the results of a systematic review of all available clinical and scientific evidence pertaining to the treatment of unipolar depressive disorders and offer practical recommendations for general practitioners encountering patients with these conditions. The guidelines cover disease definition, classification, epidemiology and course of unipolar depressive disorders, and the principles of management in the acute, continuation and maintenance phase. They deal primarily with biological treatment (including antidepressants, other psychopharmacological and hormonal medications, electroconvulsive therapy, light therapy).

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    • "In a meta-analysis of 10 randomised, placebo-controlled studies (n = 269) in which lithium was used to augment antidepressant therapy for patients with unipolar depression or bipolar disorder (depressive phase), lithium augmentation was found to be statistically significantly more effective than placebo (OR = 3.1; 95% confidence interval [CI] 1.8–5.4) (Crossley and Bauer, 2007). Most of the trials were, however, of very short duration (2–3 weeks), and it is unclear how effective lithium augmentation is in the long term. "
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    • "Patients who have failed at least one adequate trial of one major class of antidepressant have been characterised as being in stage I of antidepressant resistance (Thase and Rush, 1997). Clinical guidelines recommend switching antidepressant if there has not been clinically meaningful improvement after initial treatment (Bauer et al., 2007; NICE, 2009; APA, 2010). There are very limited data available from double-blind randomised trials (Nolen et al., 1988, 1993; Thase et al., 2002; Lenox-Smith and Jiang, 2008) comparing monotherapy strategies in patients who were unresponsive to first-line treatment with an antidepressant. "
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    ABSTRACT: Objective This randomised, double-blind, 12-week study compared efficacy and tolerability of flexible-dose treatment with vortioxetine (10–20 mg/day) versus agomelatine (25–50 mg/day) in major depressive disorder patients with inadequate response to selective serotonin reuptake inhibitor (SSRI)/serotonin–noradrenaline reuptake inhibitor (SNRI) monotherapy. Methods Patients were switched directly from SSRI/SNRI to vortioxetine or agomelatine. Primary endpoint was change from baseline to week 8 in the Montgomery–Åsberg Depression Rating Scale (MADRS) total score analysed by mixed model for repeated measurements, using a noninferiority test followed by a superiority test. Secondary endpoints included response and remission rates, anxiety symptoms (Hamilton Anxiety Rating Scale), Clinical Global Impression, overall functioning (Sheehan Disability Scale), health-related quality of life (EuroQol 5 Dimensions), productivity (work limitation questionnaire) and family functioning (Depression and Family Functioning Scale). Results Primary endpoint noninferiority was established and vortioxetine (n = 252) was superior to agomelatine (n = 241) by 2.2 MADRS points (p < 0.01). Vortioxetine was also significantly superior in response and remission rates at weeks 8 and 12; MADRS, Hamilton Anxiety Rating Scale, Clinical Global Impression, Sheehan Disability Scale and EuroQol 5 Dimensions scores at week 4 onwards; work limitation questionnaire at week 8 and Depression and Family Functioning Scale at weeks 8 and 12. Fewer patients withdrew because of adverse events with vortioxetine (5.9% vs 9.5%). Adverse events (incidence ≥5%) were nausea, headache, dizziness and somnolence. Conclusions Vortioxetine was noninferior and significantly superior to agomelatine in major depressive disorder patients with previous inadequate response to a single course of SSRI/SNRI monotherapy. Vortioxetine was safe and well tolerated.
    Human Psychopharmacology Clinical and Experimental 09/2014; 29(5). DOI:10.1002/hup.2424 · 1.85 Impact Factor
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    • "Electroconvulsive therapy (ECT) is one of the oldest treatments in psychiatry, which has survived the test of time. Despite controversies surrounding its use it still remains one of the most efficacious treatments for many severe mental disorders.[123] However, lot of stigma is attached to the use of ECT, which undermines the acceptance of this treatment by the general public.[45] "
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    ABSTRACT: Objective: Knowledge and attitude regarding electroconvulsive therapy (ECT) is one of the important parameters for acceptance of ECT as a safe and effective treatment option. Several factors shape the knowledge and attitude of general people such as previous experience of ECT, sources of their information about ECT and prevailing myths about ECT. The present study attempted to examine the knowledge and attitude concerning ECT among patients with psychiatric disorders and their relatives. Materials and Methods: Knowledge and attitudes regarding ECT were assessed using the Bengali version of the ECT knowledge and attitude questionnaires, between 100 clinically stable patients with mental illnesses and their healthy relatives. Results: Majority of the patients and relatives were unaware of the basic facts about ECT. Relatives were somewhat better informed and more positive about ECT than patients, but the differences between the two groups were not significant. Previous experience of ECT did not have any major impact in knowledge and attitude in both patients and relative groups. Patients obtained information, mostly from media (44%), doctors (23%), and from personal experiences (13%). On the other hand, relatives obtained information almost equally from media (26%), doctors (27%), and experience of friends or relatives (28%). No significant difference was observed in knowledge and attitude in patients who had obtained their facts from doctors (n=23) and from other sources (n=77). Among relatives, those who had obtained their information from doctors (n=27) were better informed than those who had obtained so from other sources (n=73). Conclusions: Since patients and relatives have poor knowledge and negative attitude toward ECT, medical professionals should impart proper information about ECT to patients and relatives to increase the acceptability of this treatment.
    Indian Journal of Psychological Medicine 07/2014; 36(3):264-9. DOI:10.4103/0253-7176.135376
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