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2017 ; 62
(1
): 11-23
Nephropedia Template TP
gab.com Text
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English Wikipedia
Systematic Review of Clinical Practice Guidelines for Failed Antidepressant
Treatment Response in Major Depressive Disorder, Dysthymia, and Subthreshold
Depression in Adults
#MMPMID27554483
MacQueen G
; Santaguida P
; Keshavarz H
; Jaworska N
; Levine M
; Beyene J
; Raina P
Can J Psychiatry
2017[Jan]; 62
(1
): 11-23
PMID27554483
show ga
OBJECTIVE: This systematic review critically evaluated clinical practice
guidelines (CPGs) for treating adults with major depressive disorder, dysthymia,
or subthreshold or minor depression for recommendations following inadequate
response to first-line treatment with selective serotonin reuptake inhibitors
(SSRIs). METHOD: Searches for CPGs (January 2004 to November 2014) in English
included 7 bibliographic databases and grey literature sources using CPG and
depression as the keywords. Two raters selected CPGs on depression with a
national scope. Data extraction included definitions of adequate response and
recommended treatment options. Two raters assessed quality using the Appraisal of
Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS: From
46,908 citations, 3167 were screened at full text. From these 21 CPG were
applicable to adults in primary care and outpatient settings. Five CPGs consider
patients with dysthymia or subthreshold or minor depression. None provides
recommendations for those who do not respond to first-line SSRI treatment. For
adults with MDD, most CPGs do not define an "inadequate response" or provide
specific suggestions regarding how to choose alternative medications when
switching to an alternative antidepressant. There is variability between CPGs in
recommending combination strategies. AGREE II ratings for stakeholder involvement
in CPG development, editorial independence, and rigor of development are domains
in which depression guidelines are often less robust. CONCLUSIONS: About half of
patients with depression require second-line treatment to achieve remission.
Consistency and clarity in guidelines for second-line treatment of depression are
therefore important for clinicians but lacking in most current guidelines. This
may reflect a paucity of primary studies upon which to base conclusions.