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Advances in Psychiatric Treatment (2003) 9: 11-20
© 2003 The Royal College of Psychiatrists

Drug treatment of depression: reflections on the evidence

Ian M. Anderson

Ian Anderson is a senior lecturer and honorary consultant psychiatrist at Manchester Royal Infirmary (University of Manchester, Neuroscience and Psychiatry Unit, Room G809, Stopford Building, Oxford Road, Manchester M13 9PT, UK. Tel: 0161 275 7428; fax: 0161 275 7429; e-mail: ian.anderson{at}man.ac.uk). His research interests are in the psychopharmacology of affective disorders and in evidence-based psychiatry.

Guidelines are readily available for the treatment of depression, and more recent ones are explicitly evidence-based. Their core messages vary little but they tend to minimise uncertainties and gloss over difficult areas. This article examines three areas of uncertainty: the thresholds of severity and, for milder depression, the duration of illness for which antidepressants are more effective than placebo; the next step in drug treatment when a patient has failed to respond adequately to a first antidepressant; and how long continuing on antidepressants should be recommended in relation to individual patients’ needs. It is concluded that the uncertainties in relation to treating individual patients are a combination of lack of evidence and individual patient factors but there is also an intrinsic uncertainty that will continue to require good clinical judgement.




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