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Quality Measures Database

Detailed Results


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Medication Offered First in Severe Depression Overall Rank: 92
In moderate to severe depression, antidepressant medication should be routinely offered to all patients before psychological interventions.
Any of several psychological disorders characterized by abnormal emotional states and including especially major depressive disorder and bipolar disorder. Also called affective disorder.
Additional Domain(s) : Psychotherapy, Medication
Rationale
There is more evidence for the effectiveness of antidepressant medication in moderate to severe depression than in milder depression. Antidepressants are as effective as psychological interventions, widely available and cost less.
Careful monitoring of symptoms, side effects and suicide risk (particularly in those aged under 30) should be routinely undertaken, especially when initiating antidepressant medication. Patient preference and past experience of treatment, and particular patient characteristics should inform the choice of drug. It is also important to monitor patients for relapse and discontinuation/withdrawal symptoms when reducing or stopping medication. Patients should be warned about the risks of reducing or stopping medication.

Randomised controlled trial (RCT) evidence indicates that for many patients there is little clinically important difference between antidepressants and placebo, and the placebo response is greatest in mild depression.
Primary Reference
Depression-Management of depression in primary and secondary care. Clinical Guideline 23.NICE. December 2004. Section 4.5.2.1; p: 62. Section 6.11.1.5; p: 171. Retrieved on Aug 3, 2006 from: http://www.nice.org.uk/page.aspx?o=cg023niceguideline
Level of Evidence
II: Less rigorous studies specifically focused on primary mental health care or extrapolated from higher quality studies from secondary mental health care.

Summarized CommentsAdd Comment
  • All choices should be presented without bias and with evidence so that the patient, or client, can make an informed decision with the help of their health care provider.
  • Consideration/ testing for alternative physical aetiologies should be made before prescribing meds.
Variation in Results
Ratings-based Rank
Relevance 128
Actionability 66
Overall Importance 75
 
Stakeholder Rank
Academics 79
Clinicians 76
Consumers 120
Decision Makers 91
 
Special Group Rank
First Nations 82
Rural Areas 103
Federal Stakeholders 84
Regional Rank
BC AB SK MB ON QC NB NS PE NL YT NT NU
102 99 95 132 119 64 47 27 18 119 134 85 37
 
Overall Rank

      

92


SA10h (B384)

 
Distribution of Survey Respondent Ratings
Relevance
100
90
80
70
60
50
40
30
20
10
0
3.9 1.69 2.94 3.22 8.19 14.02 30.63 22.3 13.11
1 2 3 4 5 6 7 8 9
Low High
Actionability
100
90
80
70
60
50
40
30
20
10
0
2.04 0.97 1.97 2.28 5.66 12.93 30.38 27.77 16.01
1 2 3 4 5 6 7 8 9
Low High
Overall Importance
100
90
80
70
60
50
40
30
20
10
0
17.12 24.05 58.83
3 2 1

3 = can live without
2 = nice to have
1 = indispensable
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The views expressed herein do not necessarily represent the official policies of Health Canada