In many countries, pain is the most common indication for use of antidepressants in older adults. We reviewed the evidence from randomized controlled trials on the efficacy and safety of antidepressants, compared to all alternatives for pain in older adults (aged ≥65 years). Open access article - no login required
Too late to be included in this review, NICE Guideline Depression in adults, was issued in 2022 with more complete tapering information, including an exponential taper to be adjusted to the tolerance of the individual patient. It advised clinicians “slowly reduce the dose to zero in a step-wise fashion, at each step prescribing a proportion of the previous dose” and “consider using smaller reductions”. While this is still not very specific, it is a significant improvement over the guidance reviewed in this paper.
Open access. Depression is usually managed in primary care, but most antidepressant trials are of patients from secondary care mental health services, with eligibility criteria based on diagnosis and severity of depressive symptoms. Antidepressants are now used in a much wider group of people than in previous regulatory trials. We investigated the clinical effectiveness of sertraline in patients in primary care with depressive symptoms ranging from mild to severe and tested the role of severity and duration in treatment response..
One of the most exciting recent breakthroughs from research funded by the National Institute of Mental Health, or NIMH, is the development of a fast-acting medication for treatment-resistant depression based on ketamine
Andrea Cipriani and Anneka Tomlinson scrutinise a brand new umbrella review of the associations between antidepressants safe and adverse health outcomes.
Douglas Badenoch on a meta-analysis of follow-up data from clinical trials of antidepressants, which found a small but significant increase in suicide risk.
About half or more of treatment‐resistant depressed patients do not respond to ketamine, and few clinical predictors to gauge the most likely antidepressant response have been proposed. We explored whether depression subtypes are associated with response to ketamine.. To read the full article, log in using your NHS Athens details. To access full-text: click “Log in/Register” (top right hand side). Click ‘Institutional Login’ then select 'OpenAthens Federation', then ‘NHS England’. Enter your Athens details to view the article.
We thank Dr. Balon (1) and Drs. Baldessarini and Vàzquez (2) for their letters concerning our meta‐analysis of randomized clinical trials (RCTs) showing antidepressant effects of anti‐inflammatory agents (3). The authors emphasize several important aspects, which we would like to comment on to continue this important discussion.. To read the full article, log in using your NHS Athens details. To access full-text: click “Log in/Register” (top right hand side). Click ‘Institutional Login’ then select 'OpenAthens Federation', then ‘NHS England’. Enter your Athens details to view the article.
Correspondence. Recently, intranasal esketamine spray (Spravato®) was approved by the Food and Drug Administration in the United States of America for its use in treatment‐resistant depression (TRD), after clinical trials demonstrating its antidepressant efficacy and positive effects on suicidal ideation1. The antidepressant mechanisms of action of ketamine‐related molecules, ethical implications, and long‐term safety issues should be addressed.. To read the full article, log in using your NHS Athens details. To access full-text: click “Log in/Register” (top right hand side). Click ‘Institutional Login’ then select 'OpenAthens Federation', then ‘NHS England’. Enter your Athens details to view the article.
To explore the temporal dynamic of antidepressant and antipsychotic co‐prescribing in real‐life conditions.. To read the full article, log in using your NHS Athens details. To access full-text: click “Log in/Register” (top right hand side). Click ‘Institutional Login’ then select 'OpenAthens Federation', then ‘NHS England’. Enter your Athens details to view the article.
Jonathon Tomlinson on a new systematic review and dose-response meta-analysis that looks at the optimal doses antidepressants for adults with depression.
Depression is the single largest contributor to non-fatal health loss worldwide. Second-generation antidepressants are the first-line option for pharmacological management of depression. Optimising their use is crucial in reducing the burden of depression; however, debate about their dose dependency and their optimal target dose is ongoing. We have aimed to summarise the currently available best evidence to inform this clinical question.. Please contact the library to request a copy of this article - http://bit.ly/2HjNDf3
In the most exhaustive investigation to date—an important contribution because of its broad scope and methodological rigour—Toshi A Furukawa and colleagues1 report findings that resonate well with earlier efforts: selective serotonin reuptake inhibitors (SSRIs) display dose-dependent beneficial effects up to the low-to-medium end of their licensed doses,2, 3, 4 and so do mirtazapine and venlafaxine. Offsetting this beneficial effect is the well-known increase in dropouts due to side-effects, which comes with higher doses.1, 2, 3 On balance, Furukawa and colleagues conclude that the lower range of licensed doses is likely to yield the best (achievable) balance between efficacy, tolerability, and acceptability.1 . Please contact the library to request a copy of this article - http://bit.ly/2HjNDf3
Existing advice from the National Institute for Health and Care Excellence (NICE) – which provides national guidance to improve health and social care in England – suggests most people should be able to come off antidepressants over four weeks.
However, it is increasingly apparent from the experiences shared by some patients and clinicians, including GPs, that some patients can suffer from more severe symptoms that can last much longer. This may affect those who have been prescribed antidepressants over a long period and who have stopped their use too quickly.
About one-third of patients with depression fail to achieve remission despite treatment with multiple antidepressants. This study compared the efficacy and safety of switching patients with treatment-resistant depression from an ineffective antidepressant to flexibly dosed esketamine nasal spray plus a newly initiated antidepressant or to a newly initiated antidepressant (active comparator) plus placebo nasal spray.. Login at top right hand side of page using your MPFT NHS OpenAthens for full text.
To assess adverse effects of pharmacologic antidepressants for treatment of major depressive disorder (MDD) in adults 65 years of age or older.....by Sobieraj et al. . To read the full article, log in using your NHS Athens details. To access full-text: click “Log in/Register” (top right hand side). Click ‘Institutional Login’ then select 'OpenAthens Federation', then ‘NHS England’. Enter your Athens details to view the article.
Letter. The recent meta‐analytic review of trials involving anti‐inflammatory agents to treat or to supplement treatment of patients with major depressive disorder (MDD) or depressive symptoms by Köhler‐Forsberg and colleagues [1] includes data derived from 36 controlled trials.