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Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review [Internet]

Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review [Internet]

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US)

Version: December 2011

Results

This chapter is organized as follows: first by Key Question (KQ), second by subquestion or subpopulation, and third by intervention comparison. In addition, according to the specifications from the Agency for Healthcare Research and Quality (AHRQ) for comparative effectiveness reviews (CER), within each KQ section we present an overview, then key points, and finally detailed analyses. Finally, as explained in Methods, we graded the strength of evidence for all major comparisons and outcomes in the key points. Table 7 summarizes the main issues that we address here.

Executive Summary

Depressive disorders such as major depressive disorder (MDD), dysthymia, and subsyndromal depression (including minor depression) may be serious disabling illnesses. MDD is the most prevalent, affecting more than 16 percent (lifetime) of U.S. adults. In 2000, the U.S. economic burden of depressive disorders was estimated to be $83.1 billion. Likely, this number has increased during the past 10 years. More than 30 percent of these costs are attributable to direct medical expenses.

Discussion

We first draw general conclusions about the findings of this comparative effectiveness review and present the strength of the evidence supporting these conclusions. We then discuss findings of each Key Question in more detail and, if relevant, put results into context with other studies. Finally, we outline topics for future research based on areas for which we have identified gaps in the current evidence.

Introduction

Axis I psychiatric disorders such as depressive disorder can be serious disabling illnesses. Combined, they affect approximately one in five Americans. Major depressive disorder (MDD) is the most prevalent, affecting more than 16 percent (lifetime) of U.S. adults. The U.S. economic burden of depressive disorders is estimated to be more than $83 billion annually. More than 30 percent of these costs were attributable to direct medical expenses. Projected depression-related U.S. workforce productivity losses are estimated to be $24 billion annually.

Methods

This chapter documents all the methods used to conduct and produce this updated comparative effectiveness review (CER) on second-generation antidepressants for the Agency for Healthcare Research and Quality (AHRQ) through its Effective Health Care Program (www.effectivehealthcare.ahrq.gov). Because it is an update, we begin with an overview of the main changes to or differences in methods since we produced the initial report in 2007.

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