Thinking about Antidepressants

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In 2008 and 2009, there have been several publications which increase our understanding of antidepressants, their risks and benefits. This site brings together some of those papers in the hope that psychiatrists and their patients will find it helpful when deciding whether to use an antidepressant, and if so, which one. The major studies were: 1. STAR*D (Sequenced Treatment Alternatives to Relieve Depression). It produced a mass of papers, which have been distilled down into the following notes and reviews 1, 2, 3. 2. 26th Feb 2008, PLoS Medicine published the Hull meta-analysis of anti-depressant trials, including unpublished studies, obtained from the FDA under Freedom of Information legislation. 4 3. 18th November 2008, the American College of Physicians published two background papers 5, 6, 4. 28th January 2009, the Lancet published online a major meta-analysis of antidepressants 7. 5. 3rd February 2009, the Canadian Medical Association Journal published a review of studies about whether SSRIs increase the risk of suicide 8. 6. June 2009, the Journal of Clinical Psychopharmacology published a meta-analysis of anti-depressant related sexual dysfunction. 9 7. August 2009, the BMJ published a meta-analysis on antidepressants and suicide. 19 8. January 2010, JAMA published a meta-analysis of the relationship between depression severity and anti-depressant efficacy. 20 How should this tsunami of new evidence shape the practice of psychiatrists and GPs? What does it say about the model we have been using to explain the biology of depression, and the part antidepressants play in treating it?