Article

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: 4.18). 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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    • "Secondly, those reporting long-term antidepressant use were more likely to satisfy formal psychiatric diagnostic criteria for depression, or to report recurrent depression, demonstrating care consistent with current antidepressant treatment guideline recommendations (American Psychiatric Association, 2010; Bambauer et al., 2007; Bauer et al., 2007; DGPPN, 2012; National Institute for Health and Clinical Excellence, 2009). Long-term antidepressant use was also associated with social disadvantage, physical and mental morbidity; with one third of long-term users reporting being unable to work and three quarters reporting that illness limited their daily activities. "
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    ABSTRACT: Antidepressants are one of the most commonly prescribed drugs in primary care. The rise in use is mostly due to an increasing number of long-term users of antidepressants (LTU AD). Little is known about the factors driving increased long-term use. We examined the socio-demographic, clinical factors and health service use characteristics associated with LTU AD to extend our understanding of the factors that may be driving the increase in antidepressant use. Cross-sectional analysis of 789 participants with probable depression (CES-D≥16) recruited from 30 randomly selected Australian general practices to take part in a ten-year cohort study about depression were surveyed about their antidepressant use. 165 (21.0%) participants reported <2 years of antidepressant use and 145 (18.4%) reported ≥2 years of antidepressant use. After adjusting for depression severity, LTU AD was associated with: single (OR 1.56, 95%CI 1.05-2.32) or recurrent episode of depression (3.44, 2.06-5.74); using SSRIs (3.85, 2.03-7.33), sedatives (2.04, 1.29-3.22), or antipsychotics (4.51, 1.67-12.17); functional limitations due to long-term illness (2.81, 1.55-5.08), poor/fair self-rated health (1.57, 1.14-2.15), inability to work (2.49, 1.37-4.53), benefits as main source of income (2.15, 1.33-3.49), GP visits longer than 20min (1.79, 1.17-2.73); rating GP visits as moderately to extremely helpful (2.71, 1.79-4.11), and more self-help practices (1.16, 1.09-1.23). All measures were self-report. Sample may not be representative of culturally different or adolescent populations. Cross-sectional design raises possibility of "confounding by indication". Long-term antidepressant use is relatively common in primary care. It occurs within the context of complex mental, physical and social morbidities. Whilst most long-term use is associated with a history of recurrent depression there remains a significant opportunity for treatment re-evaluation and timely discontinuation. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Feb 2015 · Journal of Affective Disorders
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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. "

    Full-text · Dataset · Oct 2014
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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.
    Full-text · Article · Sep 2014 · Human Psychopharmacology Clinical and Experimental
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