Rational Use of Antidepressant Drugs

Fava, Giovanni A.

doi:10.1159/000362803

Cited by 82 publications

(119 citation statements)

References 73 publications

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“…The occurrence of affective prodromes should be particularly suspected in patients having an onset of mania later than the expected age and when standard psychiatric treatments do not lead to an improvement in psychological symptoms. In fact, affective symptoms due to a medical illness tend not to fully respond to antidepressant drugs, even when properly administered [107,108], but rather to the proper treatment of the underlying medical disorder. Indeed, many patients dismissed as suffering from a mood or anxiety disorder, with an adequate follow-up, may later present with a medical illness responsible at least in part for it [109].…”

Section: Discussionmentioning

confidence: 99%

Mood and Anxiety Disorders as Early Manifestations of Medical Illness: A Systematic Review

Cosci

Fava²,

Sonino³

2014

Psychother Psychosom

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Background: Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis. Methods: MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were ‘prodrome/early symptom', combined using the Boolean ‘AND' operator with ‘anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean ‘AND' operator with ‘medical illness/medical disorder'. PRISMA guidelines were followed. Results: A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent. Conclusions: Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

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Section: Discussionmentioning

confidence: 99%

Mood and Anxiety Disorders as Early Manifestations of Medical Illness: A Systematic Review

Cosci

Fava²,

Sonino³

2014

Psychother Psychosom

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“…The longer patients remain well, the lower the risk of relapse [4]. Depressive relapse/recurrence is difficult to prevent using antidepressants only [5]. Cognitive therapy (CT) after the acute phase of depression reduces the risk of relapse [6,7,8,9,10,11,12].…”

Section: Introductionmentioning

confidence: 99%

The Three-Month Effect of Mobile Internet-Based Cognitive Therapy on the Course of Depressive Symptoms in Remitted Recurrently Depressed Patients: Results of a Randomized Controlled Trial

Kok¹,

Burger

Riper

et al. 2015

Psychother Psychosom

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Background: Internet-based cognitive therapy with monitoring via text messages (mobile CT), in addition to treatment as usual (TAU), might offer a cost-effective way to treat recurrent depression. Method: Remitted patients with at least 2 previous episodes of depression were randomized to mobile CT in addition to TAU (n = 126) or TAU only (n = 113). A linear mixed model was used to examine the effect of the treatment condition on a 3-month course of depressive symptoms after remission. Both an intention-to-treat analysis (n = 239) and a completer analysis (n = 193) were used. Depressive symptoms were assessed using the Inventory of Depressive Symptomatology (IDS-SR₃₀) at baseline and 1.5 and 3 months after randomization. Results: Residual depressive symptoms showed a small but statistically significant decrease in the intention-to-treat group over 3 months in the mobile CT group relative to the TAU group (difference: -1.60 points on the IDS-SR₃₀ per month, 95% CI = -2.64 to -0.56, p = 0.003). The effect of the treatment condition on the depressive symptomatology at the 3-month follow-up was small to moderate (Cohen's d = 0.44). All analyses among completers (≥5 modules) showed more pronounced treatment effects. Adjustment for unequally distributed variables did not markedly affect the results. Conclusions: Residual depressive symptoms after remission showed a more favorable course over 3 months in the mobile CT group compared to the TAU group. These results are a first indication that mobile CT in addition to TAU is effective in treating recurrently depressed patients in remission. However, demonstration of its long-term effectiveness and replication remains necessary.

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“…For instance, antidepressant drugs have been found to be effective in the treatment of major depressive disorders, but the magnitude of benefit of antidepressant medication compared with placebo increases with the severity of depression [13]. If a patient suffers from severe depression there is little doubt that pharmacotherapy may yield benefits, even though response may vary from patient to patient [14]. If symptoms are of mild or moderate intensity, the benefits may be minimal or nonexistent, while adverse effects may be substantial, such as switching from a unipolar to a bipolar course.…”

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confidence: 99%

“…If symptoms are of mild or moderate intensity, the benefits may be minimal or nonexistent, while adverse effects may be substantial, such as switching from a unipolar to a bipolar course. Unfortunately, the prescribing clinician is driven by an overestimated consideration of potential benefits, paying little attention to the likelihood of responsiveness and to potential vulnerabilities in relation to the adverse effects of treatment [14]. …”

mentioning

confidence: 99%

The Clinical Inadequacy of Evidence-Based Medicine and the Need for a Conceptual Framework Based on Clinical Judgment

Fava

Guidi

Rafanelli

et al. 2014

Psychother Psychosom

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Rational Use of Antidepressant Drugs

Cited by 82 publications

References 73 publications

Mood and Anxiety Disorders as Early Manifestations of Medical Illness: A Systematic Review

Mood and Anxiety Disorders as Early Manifestations of Medical Illness: A Systematic Review

The Three-Month Effect of Mobile Internet-Based Cognitive Therapy on the Course of Depressive Symptoms in Remitted Recurrently Depressed Patients: Results of a Randomized Controlled Trial

The Clinical Inadequacy of Evidence-Based Medicine and the Need for a Conceptual Framework Based on Clinical Judgment

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