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Antidepressants, watchful waiting poorly studied in primary care patients with mild-moderate depression
Clinical Question
How effective are antidepressants for primary care patients with subclinical depression, mild depression, or moderate depression?
Bottom line
The main message from this trial is that we don't know much about the treatment patients with mild to moderate depression in the primary care setting. This is a common and important problem that deserves more study. 1a
Reference
Study design: Systematic review
Funding: Government
Setting: Various (meta-analysis)
Synopsis
Patients with mild to moderate depression, as well as patients with depressive symptoms that do not meet the formal criteria for depression ("subclinical depression"), are commonly treated with antidepressants in the primary care setting. These authors set out to evaluate the evidence base for this practice. They searched the literature for studies that compared the approach recommended by European guidelines—watchful waiting; ie, supportive discussion, problem solving, education, and sometimes low-intensity psychological interventions—with the approach recommended by US guidelines—drug therapy. The authors ultimately found only 3 studies with a total of 181 adult patients that compared watchful waiting (as described above) with a selective serotonin reuptake inhibitor. The studies followed up patients for 6 to 12 months and were generally of good quality; none were double-blinded (which would have been challenging because of the nature of the intervention). The studies found some benefits that favored antidepressants, but only for some outcomes and of questionable clinical significance.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Although chronic pain treated with antidepressant and may be effective for few month but after that patient becomes dependent and will be more difficult to control pain and in the of surgery when patient using antidepressant for pain or sleep post result is good but patient is more anxious. But there are no difference when patient is on antidepressant for preexisting Depression.
I already offer patients a variety of non-pharm ideas but some want to try anti-depressants and some fail with the non-pharm modalities which them makes medication a reasonable alternative as a trial.
I think that antidepressants are like the benzodiazepines when they were first launched- everybody used them , then came increasing evidence of addiction, overdoses, and other unexpected outcomes. I think both of these have been over sold. I have found that sympathetic listening and reassurance go a long way.