Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression

H. J. Möller, I. Bitter, J. Bobes, K. Fountoulakis, C. Höschl, S. Kasper

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5-7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of 'the right drug/treatment for the right patient' is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.

Original languageEnglish
Pages (from-to)114-128
Number of pages15
JournalEuropean Psychiatry
Volume27
Issue number2
DOIs
Publication statusPublished - Feb 2012

Fingerprint

Depressive Disorder
Antidepressive Agents
Psychiatry
Therapeutics
Pharmaceutical Preparations
Depression
Numbers Needed To Treat
Drug Monitoring
Evidence-Based Medicine
Pharmacogenetics
Personality Disorders
Patient Rights
Psychotherapy
Placebos

Keywords

  • Antidepressants
  • Depression treatment
  • Efficacy
  • Review
  • Suicidality

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression. / Möller, H. J.; Bitter, I.; Bobes, J.; Fountoulakis, K.; Höschl, C.; Kasper, S.

In: European Psychiatry, Vol. 27, No. 2, 02.2012, p. 114-128.

Research output: Contribution to journalArticle

Möller, H. J. ; Bitter, I. ; Bobes, J. ; Fountoulakis, K. ; Höschl, C. ; Kasper, S. / Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression. In: European Psychiatry. 2012 ; Vol. 27, No. 2. pp. 114-128.
@article{7f2a3722eace42d4b6af2ce78847521d,
title = "Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression",
abstract = "This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5-7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of 'the right drug/treatment for the right patient' is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.",
keywords = "Antidepressants, Depression treatment, Efficacy, Review, Suicidality",
author = "M{\"o}ller, {H. J.} and I. Bitter and J. Bobes and K. Fountoulakis and C. H{\"o}schl and S. Kasper",
year = "2012",
month = "2",
doi = "10.1016/j.eurpsy.2011.08.002",
language = "English",
volume = "27",
pages = "114--128",
journal = "Psychiatrie et Psychobiologie",
issn = "0924-9338",
publisher = "Psychiatrie & psychobiologie",
number = "2",

}

TY - JOUR

T1 - Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression

AU - Möller, H. J.

AU - Bitter, I.

AU - Bobes, J.

AU - Fountoulakis, K.

AU - Höschl, C.

AU - Kasper, S.

PY - 2012/2

Y1 - 2012/2

N2 - This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5-7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of 'the right drug/treatment for the right patient' is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.

AB - This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5-7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of 'the right drug/treatment for the right patient' is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.

KW - Antidepressants

KW - Depression treatment

KW - Efficacy

KW - Review

KW - Suicidality

UR - http://www.scopus.com/inward/record.url?scp=84856582927&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856582927&partnerID=8YFLogxK

U2 - 10.1016/j.eurpsy.2011.08.002

DO - 10.1016/j.eurpsy.2011.08.002

M3 - Article

C2 - 22119161

AN - SCOPUS:84856582927

VL - 27

SP - 114

EP - 128

JO - Psychiatrie et Psychobiologie

JF - Psychiatrie et Psychobiologie

SN - 0924-9338

IS - 2

ER -