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Are the newer antidepressant drugs as effective as established physical treatments? Results from an Australasian clinical panel review

Authors

  • Gordon Parker,

  • Philip Mitchell,

  • Kay Wilhelm,

  • David Menkes,

  • John Snowdon,

  • Isaac Schweitzer,

  • David Grounds,

  • Paul Skerritt,

  • Kay Roy,

  • Dusan Hadzi-Pavlovic


  • School of Psychiatry, University of New South Wales, and Mood Disorders Unit, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia. Email: g.parker@unsw.edu.au

  • David Menkes, Liaison Psychiatrist

  • Dunedin Hospital, Aotearoa, New Zealand

  • John Snowdon, Associate Professor

  • University of Sydney, Sydney, Australia

  • Isaac Schweitzer, Associate Professor

  • University of Melbourne, Melbourne, Australia

  • David Grounds, Psychiatrist

  • Melbourne Clinic, Melbourne, Australia

  • Paul Skerritt, Psychiatrist

  • Mental Health Service, Joondalup Health Campus, Perth, Australia

GordonParker Professor (Correspondence); Philip Mitchell, Professor; Kay Wilhelm, Associate Professor; Kay Roy, Research Assistant

Abstract

Objective: The aim of this study was to determine, in a clinical panel sample, the extent to which patients with depression (and melancholic and non-melancholic subtypes) judged the effectiveness of previously received antidepressant treatments, particularly the comparative effectiveness of the older and newer antidepressant drugs.

Method: Twenty-seven Australasian psychiatrists assessed 341 non-psychotic depressed patients and rated the extent to which previous antidepressant treatments had been effective. Patients were assigned to ‘melancholic’ and residual ‘non-melancholic’ categories by two processes (DSM-IV decision rules, and a cluster analysis-derived allocation) and treatment effectiveness examined within each category.

Results: Electroconvulsive therapy (both bilateral and unilateral) was judged as highly effective by both melancholic and non-melancholic patients. Antipsychotic medication similarly rated highly (but was judged as more effective by the non-melancholic than melancholic patients). The tricyclics and irreversible monoamine oxidase inhibitors (MAOIs) were rated as more effective by the whole sample than several newer antidepressant classes (including the selective serotonin re-uptake inhibitors SSRIs], venlafaxine, mianserin and moclobemide), whether effectiveness was examined dimensionally or categorically. Comparison of the overall tricyclic and SSRI classes indicated that any superior tricyclic effectiveness was specific to the melancholic subjects.

Conclusions: Despite methodological limitations intrinsic to such clinical panel data, the judged greater effectiveness of the older antidepressants (tricyclics and irreversible MAOIs) for melancholic depression is of importance. If valid, such data are of intrinsic clinical relevance but also have the potential to inform us about the neurobiological determinants of ‘melancholia’ and pharmacological actions which contribute to its effective treatment.

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