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Guidelines clarify use of newer antidepressants.

Second-generation antidepressants are similarly effective in the treatment of major depression in adults, thus drug selection should be driven by adverse event profile, cost, and patient preference, according to a clinical practice guideline issued by the American College of Physicians.

Basing their conclusions on evidence derived from 203 clinical studies involving selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and selective serotonin norepinephrine reuptake inhibitors (SSNRIs), the guideline authors wrote that "existing evidence does not justify the choice of any second-generation antidepressant over another on the basis of greater efficacy and effectiveness."

Because the various agents are associated with different adverse events, "physicians and patients should discuss adverse event profiles before selecting a medication," the authors wrote (Ann. Intern.

Med. 2008;149:725-33).

For example, although sexual dysfunction is a commonly reported adverse event associated with second-generation antidepressants, "bupropion is associated with a lower rate of sexual adverse events than fluoxetine or sertraline, whereas paroxetine has higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline," they stated. The practice guideline also recommends that clinicians:

* Regularly assess patient status, therapeutic response, and adverse effects of antidepressant therapy beginning within 1-2 weeks of treatment initiation.

* Modify treatment if there is not an adequate response within 6-8 weeks.

* Continue treatment for 4-9 months after a satisfactory response in patients with a first episode of major depressive disorder; and consider longer treatment after a response in patients who have had two or more episodes of depression.


New England Bureau

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Title Annotation:MENTAL HEALTH
Author:Mahoney, Diana
Publication:Family Practice News
Article Type:Clinical report
Date:Jan 1, 2009
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