Choice of Treatment with Antidepressants: Influencing Factors

Abstract

Depressive disorders place a large burden on patients and on society. Although efficacious treatment options for unipolar depressive disorders exist, substantial gaps in care remain. In part, the challenge lies in the matching of individual patients with appropriate care. This is complicated by the steady increases in the variety of antidepressants available in the market. The goal of this study is to highlight the decision processes in the selection of antidepressants by clinicians, given that most treatments have similar clinical effectiveness profiles. We conducted a systematic literature review of studies that referred to the decisions surrounding treatment with antidepressants for the treatment of non-psychotic unipolar depression. Our analysis of the literature reveals that the choice of treatment is based on a variety of factors, of which clinical evidence is only one. These factors can be categorized into clinical factors such as illness and treatment characteristics, individual factors such as patient and physician characteristics, and contextual factors such as setting characteristics, decision supports and pharmacoeconomic aspects. Illness characteristics are defined by the type and severity of depression. Treatment characteristics include drug properties, efficacy, effectiveness and favorable as well as unintended adverse effects of the drug. Examples for patient characteristics are co-morbidities and individual preferences, and physician characteristics include knowledge, experience, values and beliefs, and the relationship with the patient. Treatment guidelines, algorithms, and most recently, computational supports and biological markers serve as decision supports.

Brain arousal regulation as response predictor for antidepressant therapy in major depression

“…According to the naturalistic design of the study, treatment was conducted to the therapists’ decision based on a therapeutic algorithm applied at the study centre51. In short, antidepressant therapy within the first 4 weeks of treatment regularly consisted of a monotherapy with either escitalopram or mirtazapine (N = 53).…”

Impact of Antidepressants on Cytokine Production of Depressed Patients in Vitro

“…Citalopram and its active S-enantiomer named escitalopram are selective-serotonin reuptake inhibitors (SSRI). Escitalopram compared to citalopram has been reported as having greater efficacy, fewer side effects, and greater cost-effectiveness due to higher relapse prevention and reduced hospital stay [31,32,33,34,35,36]. Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA), structurally also classifiable as a tetracyclic antidepressant (TeCA).…”

Economic evaluation of agomelatine relative to other antidepressants for treatment of major depressive disorders in Greece

“…Based on a recently published review by Himmerich & Wranik, the potential determinants of antidepressant treatment choice are classified into seven categories, including illness and treatment characteristics, patient and physician characteristics, treatment setting characteristics, decision supports and pharmacoeconomic aspects [42]. …”