Pills or therapy--which is better?

L D Thomas

doi:10.1016/s1322-7696(08)60238-3

Home/Archive/PubMed

PubMed · 9295552

Pills or therapy--which is better?

L D Thomas

View original source ↗Export metadata ↓

Abstract

The debate about the strengths and limitations of psychotherapy in the treatment of depression has been bolstered in a critique by Mufioz et al (1994) of the US Agency for Health Care Policy and Research (AHCPR) 'Depression in Primary Care' guidelines. The author's evaluation of the guidelines suggest that psychotherapy alone is more effective than medication and that combined psychotherapy with medication is no more effective than psychotherapy alone. Such data has important implications for the management of depressions in Australia and provides support for the role of the nurse/therapist within the treatment team.

Explore related subjects

Antidepressive Agents Combined Modality Therapy Depressive Disorder Humans Practice Guidelines as Topic Psychotherapy Treatment Outcome Comparative Study Journal Article Review

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

L D Thomas. 1997. Pills or therapy--which is better?. https://doi.org/10.1016/s1322-7696(08)60238-3

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Seizure incidence in psychopharmacological clinical trials: an analysis of Food and Drug Administration (FDA) summary basis of approval reports.

BACKGROUND: Clinical trial data provide an approach to the investigation of the effects of psychopharmacological agents, and psychiatric disorders themselves, on seizure threshold. METHODS: We accessed public domain data from Food and Drug Administration (FDA) Phase II and III clinical trials as Summary Basis of Approval (SBA) reports that noted seizure incidence in trials of psychotropic drugs approved in the United States between 1985 and 2004, involving a total of 75,873 patients. We compared seizure incidence among active drug and placebo groups in psychopharmacological clinical trials and the published rates of unprovoked seizures in the general population. RESULTS: Increased seizure incidence was observed with antipsychotics that was accounted for by clozapine and olanzapine, and with drugs indicated for the treatment of OCD that was accounted for by clomipramine. Alprazolam, bupropion immediate release (IR) form, and quetiapine were also associated with higher seizure incidence. The incidence of seizures was significantly lower among patients assigned to antidepressants compared to placebo (standardized incidence ratio = .48; 95% CI, .36- .61). In patients assigned to placebo, seizure incidence was greater than the published incidence of unprovoked seizures in community nonpatient samples. CONCLUSIONS: Proconvulsant effects are associated with a subgroup of psychotropic drugs. Second-generation antidepressants other than bupropion have an apparent anticonvulsant effect. Depression, psychotic disorders, and OCD are associated with reduced seizure threshold.

Antidepressive Agents↗

PubMed2007

The sales of antidepressants and suicide rates in Norway and its counties 1980-2004.

BACKGROUND: Suicide is a major public health problem and depression is among the most important risk factors for suicide. Treatment of depression might prevent suicide. To study this hypothesis further we conducted an ecological study. METHODS: An ecological study using sales data for antidepressants and numbers of suicides in Norway and Norwegian counties 1980-2004 was performed. Data on alcohol consumption and unemployment rates were registered and taken into account. Data were analyzed using Cochrane-Orcutt time series for the country as a whole. The county specific data were analyzed with a random coefficient model with county as subject and intercept and time (slope) as random variables using an unstructured covariance matrix. RESULTS: Sales of non-tricyclic antidepressants (non-TCAs) and suicide were clearly negatively related, even when controlling for alcohol and unemployment (adjusted r(2): 0.57). There was an effect modification between time and level of sales of non-TCAs. Studying the relationship between the sales of non-TCAs and the suicide rate, we found that it was significant and stronger for the low sales figures, but non-existent for the high sales figures. LIMITATIONS: Ecological studies cannot infer causality. CONCLUSIONS: The fall in suicide rates in Norway and its counties was related to the increased sales of non-TCAs. The effect was mostly a result of a sales increase in the lower sales segment, indicating that a change from the more toxic TCAs, or heightened awareness of depression and its treatment, could explain the relationship found between sales of newer antidepressants and a decrease in suicide rate.

Antidepressive Agents↗

PubMed2007

Pricing matrix model: dealing with uncertainty.

A previous publication in this journal showed that the pricing matrix model (PMM) allows an assessment of the pricing potential of a new innovative product. When the PMM is going to be used for the determination of a drug price for a new drug in the strategic product planning process, it is important that this methodology is reliable. In the initial paper the PMM only yielded an expected price for the new antidepressant without generating an estimate of the probability that the new drug would indeed be listed at this expected price. In this manuscript we present various methodologies to deal with uncertainty in the PMM. We introduce the concept of price acceptability curves. The conclusion of this paper is that the incorporation of uncertainty into the PMM will lead to a more accurate assessment of the pricing potential of a new drug.

Antidepressive Agents↗