Philosophy

According to the Agency for Healthcare Research and Quality (1999), Depressive disorders are grave and disabling diseases. It is approximated that at least one out of five people are affected by this disorder in their lifetime. This disorder brings about devastating economic effects to the individual and to the family. In the United States alone it is estimated that financial costs for the management of depressive disorders are higher than 44 billion (Agency for Healthcare Research and Quality, 1999).

Personal impacts of the disease are reflected by the high rate of mortality as well as impairment in multiple areas of functioning. WHO approximates that depressive disorders are the fourth most significant causes of disability globally. The United States Department of Human Health and Services in the late 1980s, as indicated by the Agency for Healthcare Research and Quality (1999), supported the establishment of standard guidelines for depressive disorders especially major depression. These guidelines played a very important role in advancing knowledge although evidence was inadequate to deal with numerous clinically significant questions. From that time onwards, publicized focus on dealing with and treating depression and also on the development of various antidepressants have resulted in tremendous growth in prescribing of antidepressants in addition to increasing costs for health plans. Clinicians have been faced by confusion in making a choice between herbal remedies and novel antidepressants.

This report is aimed at helping clinicians choose wisely between herbal remedies and new antidepressants. It also aims at assisting organizations establish clinical guidelines for the treatment of depressive disorders. A far reaching assessment of the advantages and the disadvantages of herbal drugs and new antidepressants for use in the treatment of depressive disorders in both adults and children, are provided in this report. Various newer pharmacotherapies and herbal drugs are focused on in this report. Antidepressants developed earlier are only considered when they are being compared with a newer antidepressant (Agency for Healthcare Research and Quality, 1999). This report addresses the efficacy of newer antidepressants for use in the management of most prevalent forms of depressive disorders. It also addresses questions regarding the efficacy of newer antidepressants as compared to psychosocial therapies as well as the efficacy of herbal treatments. Specific populations are focused on in this report children as well as adolescents in specific settings (Agency for Healthcare Research and Quality, 1999).

Literature was extracted from special records of about 8, 415 articles dealing with clinical trials and references from relevant meta-analysis and professionals (Agency for Healthcare Research and Quality, 1999). Trials in these records addressed depressive disorders identified from numerous sources including electronic databases. Evaluation of sources was carried out within a period of 18 years, from 1980-1998, so as to obtain literature pertinent to new pharmacotherapies.  Various terms referring to depressive disorders were put together with a list of newer antidepressants as well as herbal therapies to make 1,277 records (Agency for Healthcare Research and Quality, 1999).

Randomized controlled trials that lasted for six weeks were reviewed. Most of these trials compared a newer antidepressant with an older one, a placebo or a psychosocial therapy. Most trials involved patients of depressive disorders who had a clinical outcome. This review identified grave but rare effects of various drugs. Articles from databases were searched based on the effects of various drugs.

Specific words such as serious, sever, adverse, and poisoning were used during database search for articles (Agency for Healthcare Research and Quality, 1999). Data obtained from each clinical trial was independently abstracted by two people. It was then synthesized descriptively focusing on participants as well as diagnostic descriptors, characteristics for intervention, designs of various studies, and outcomes of the trials. Empirical Bayes random-effects estimator technique was used to qualitatively analyze some data. The most important results were response rate of symptoms, dropouts, and the rate of discontinuation as a result of serious effects. Response rate, according to Agency for Healthcare Research and Quality (1999), was recorded as 50, or more symptomatic improvement, as evaluated using a depression symptoms rating scale. These rates were calculated with the help of a modified intention-to-treat approach. Considering that some of those who dropped out of the study may have responded, analysis using the modified intention-to-treat generated a conservative approximate of the effect of treatment. Based on endpoint technique a sensitivity test was carried out with the denominator for the risk ratio being the number of those who completed follow up (Agency for Healthcare Research and Quality, 1999).

Approximately 300 randomized trials assessed new antidepressants with most of them focusing on major depression.  Other studies focused on dysthymia, subsyndromal and anxiety disorders (Agency for Healthcare Research and Quality, 1999). More than 100 trials compared the efficacy of new pharmacotherapies to placebo. Most trials, as illustrated by the Agency for Healthcare Research and Quality (1999), used a double blind method that lasted for about 6-8 weeks. Reporting of most of these trials was incomplete. Very few studies described the setting of the study, nature and the content of clinical relations between participants and providers, the socio-economic status and cultural background of the participants. Secondary results were also reported irregularly for analysis (Agency for Healthcare Research and Quality, 1999).

More than 80 of the studies proved newer antidepressants as more effective drugs as compared to placebo for the treatment of depressive disorders, with response rate being more than half for active treatment and less that half for placebo (Agency for Healthcare Research and Quality, 1999). The study also realized that newer antidepressants are equally effective as compared to older pharmacotherapies. It was concluded that new antidepressants are the drugs of choice for the treatment of depressive disorders. From this assignment I have learnt how the correct procedure to follow while reporting a research. I have also learned that for a drug to be considered effective it has to undergo extensive evaluation.