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Antidepressant use in clinical practice: efficacy v. effectiveness

  • John Donoghue (a1) and Timothy R. Hylan (a2)
Abstract
Background

Although the efficacy of antidepressants has been demonstrated in randomised, controlled clinical trials, it is how an antidepressant is used in clinical practice that determines its clinical effectiveness, or real-world efficacy.

Aims

To explore the frequency with which antidepressants are used at adequate dose and duration to obtain remission of symptoms and prevent relapse in clinical practice and discuss potential implications for clinical outcomes.

Method

Studies of antidepressant prescribing were reviewed and comparisons made between antidepressant classes and individual compounds within those classes.

Results

Naturalistic studies show that patients who begin therapy on tricyclic antidepressants often receive sub-therapeutic doses for inadequate duration; conversely patients who begin therapy on selective serotonin reuptake inhibitors more often receive an adequate dose of therapy for a longer duration.

Conclusions

How antidepressants are used in clinical practice can determine the clinical outcomes that are achieved. Antidepressants that are more forgiving of sub-optimal prescribing and use patterns by providers and patients, respectively, may help to improve real-world efficacy.

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Copyright
Corresponding author
Mr John Donoghue, PCS Health, 4 Wrenfield Grove, Liverpool L17 9QD, UK. Tel: +44 151 726 1860; e-mail: john@donoghue.u-net.com.
Footnotes
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Declaration of interest

J. D. received an honorarium and travel expenses from Eli Lilly & Co. At the time of manuscript preparation, T. R. H. was employed at Eli Lilly & Co.

Footnotes
References
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Agency for Health Care Policy Research (1993) Treatment of Major Depression, Vol. 2. Clinical Practice Guidelines, No. 5, Publication 93–0050. Rockville, MD: US Department of Health and Human Services.
Ali, I. M. (1998) Long-term treatment with antidepressants in primary care. Psychiatric Bulletin, 22, 1519.
Altamura, A. & Percudani, M. (1993) The use of antidepressants for long-term treatment of recurrent depression: rationale, current methodologies, and future direction. Journal of Clinical Psychiatry, 54 (suppl. 8), 2938.
Anderson, I. M. (1998) SSRIs versus tricyclic antidepressants in depressed inpatients: ameta-analysis of efficacy and tolerability. Depression and Anxiety, 7 (suppl. 1), 1117.
Anderson, I. M. (2000) Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. Journal of Affective Disorders, 58, 1936.
Anderson, I. M. & Tomenson, B. M. (1994) The efficacy of selective serotonin reuptake inhibitors in depression: a meta-analysis of studies against tricyclic antidepressants. Journal of Psychopharmacology, 8, 238249.
Anderson, I. M. & Tomenson, B. M. (1995) Treatment discontinuation rates with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis. British Medical Journal, 310, 14331438.
Anon. (1993) The treatment of depression in primary care. Effective Health Care, 5, 112.
Arias, F., Padin, J. J., Gilaberte, I., et al (1998) Comparative efficacy and tolerability among different selective serotonin reuptake inhibitors and venlafaxine in a naturalistic setting. International Journal of Psychiatry in Clinical Practice, 2, 255260.
Beaumont, G., Baldwin, D. & Lader, M. (1996) A criticism of the practice of prescribing subtherapeutic doses of antidepressants for the treatment of depression. Human Psychopharmacology, 11, 283291.
Bech, P. & Cialdella, P. (1992) Citalopram in depression – meta-analysis of intended and unintended effects. International Clinical Psychopharmacology, 6 (suppl. 5), 4554.
Benfield, P. & Ward, A. (1986) Fluvoxamine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs, 32, 313334.
Benfield, P., Heel, R. C. & Lewis, S. P. (1986) Fluoxetine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs, 32, 481508.
Berken, G. H., Weinstein, D. O. & Stern, W. C. (1984) Weight gain: a side-effect of tricyclic antidepressants. Journal of Affective Disorders, 7, 133138.
Bingefors, K., Isacson, D. & von Knorring, L. (1997) Antidepressant dose patterns in Swedish clinical practice. International Clinical Psychopharmacology, 12, 283290.
Blashki, T. G., Mowbray, R. & Davies, B. (1971) Controlled trial of amitriptyline in general practice. British Medical Journal, i, 133138.
Bouwer, C. D. & Harvey, B. H. (1996) Phasic craving for carbohydrate observed with citalopram. International Clinical Psychopharmacology, 11, 273278.
British Association for Psychopharmacology (1993) Guidelines for treating depressive illness with antidepressants: a statement from the British Association for Psychopharmacology. Journal of Psychopharmacology, 7, 1923.
Canadian Coordinating Office (1998) A Clinical and Economic Evaluation of Selective Serotonin Reuptake Inhibitors in Major Depression. Ontario: Canadian Coordinating Office of Health Care Technology Assessment.
Charney, D. S., Heninger, G. R., Sternberg, D. E., et al (1982) Abrupt discontinuation of tricyclic antidepressant drugs: evidence for noradrenergic hyperactivity. British Journal of Psychiatry, 141, 377386.
Coupland, N., Bell, C. J. & Potokar, J. P. (1996) Serotonin reuptake inhibitor withdrawal. Journal of Clinical Psychopharmacology, 16, 356362.
Cramer, J. A. (1995) Partial medication compliance: the enigma in poor medical outcomes. American Journal of Managed Care, 1, 167174.
Croghan, T. W., Lair, T. J., Engelhart, L., et al (1997) Effect of antidepressant therapy on health care utilization and costs in primary care. Psychiatric Services, 48, 14201426.
Dechant, K. L. & Clissold, S. P. (1991) Paroxetine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depressive illness. Drugs, 41, 225253.
Demyttenaere, K. (1997) Compliance during treatment with antidepressants. Journal of Affective Disorders, 43, 2739.
Demyttenaere, K. (1998) Noncompliance with antidepressants: who's to blame? International Clinical Psychopharmacology, 13 (suppl. 2), S19S25.
Demyttenaere, K., Van Ganse, E., Gregoire, J., et al (1998) Compliance in depressed patients treated with fluoxetine and amitriptyline. International Clinical Psychopharmacology, 13, 1117.
DeVane, C. L. (1995) Comparative safety and tolerability of selective serotonin reuptake inhibitors. Human Psychopharmacology, 10 (suppl. 3), S185S193.
Dilsaver, S. C. & Greden, J. F. (1984) Antidepressant withdrawal phenomena. Biological Psychiatry, 19, 237256.
Dilsaver, S. C., Greden, J. F. & Snider, R. M. (1987) Antidepressant withdrawal syndromes: phenomenology and physiopathology. International Clinical Psychopharmacology, 2, 119.
Donoghue, J. M. (1998a) Sub-optimal use of tricyclic antidepressants in primary care (editorial). Acta Psychiatrica Scandinavica, 98, 429431.
Donoghue, J. M. (1998b) Selective serotonin re-uptake inhibitor use in primary care: a five year naturalistic study. Clinical Drug Investigation, 16, 453462.
Donoghue, J. M. & Taylor, D. M. (2000) Suboptimal use of antidepressants in the treatment of depression. CNS Drugs, 13, 365383.
Donoghue, J. M., Taylor, D. M. & Tylee, A. (1996) The treatment of depression: prescribing patterns of antidepressants in primary care in the UK. British Journal of Psychiatry, 168, 164168.
Donoghue, J. M., Taylor, D. M. & Wildgust, H. (1996) Cross-sectional database analysis of antidepressant prescribing in general practice in the United Kingdom. British Medical Journal, 313, 861862.
Donoghue, J. M., Katona, C. & Tylee, A. (1998) The treatment of depression: antidepressant prescribing for elderly patients in primary care. Pharmaceutical Journal, 260, 500502.
Dunn, R. L., Donoghue, J. M., Ozminkowski, R. J., et al (1998) Selective serotonin reuptake inhibitor antidepressant prescribing in primary care in the United Kingdom. Primary Care Psychiatry, 8, 141148.
Dunn, R. L., Donoghue, J. M., Ozminkowski, R. J., et al (1999) Longitudinal patterns of antidepressant prescribing in primary care in the United Kingdom: a comparison to treatment guidelines. Journal of Psychopharmacology, 13, 136143.
Dunner, D. & Dunbar, G. C. (1992) Optimal dose regimen for paroxetine. Journal of Clinical Psychiatry, 53 (suppl. 2), 2126.
Edwards, J. G. (1992) Selective serotonin reuptake inhibitors. British Medical Journal, 304, 16441646.
Edwards, J. G., Inman, W. H., Wilton, L., et al (1994) Prescription-event monitoring of 10,401 patients treated with fluvoxamine. British Journal of Psychiatry, 164, 387395.
Fabre, L. F., Abuzzahab, F. S., Amin, M., et al (1995) Sertraline safety and efficacy in major depression: a double-blind fixed-dose comparison with placebo. Biological Psychiatry, 38, 592602.
Fava, M., Rosenbaum, J., Hoog, S., et al (1998) Fluoxetine versus sertraline and paroxetine in major depression: long-term changes in weight (abstract). European Neuropsychopharmacology 8 (suppl. 2), S204.
Feighner, J. P., Gardner, E. A., Johnston, J. A., et al (1991) Double-blind comparison of bupropion and fluoxetine in depressed outpatients. Journal of Clinical Psychiatry, 52, 329335.
Finley, P. R. (1994) Selective serotonin reuptake inhibitors: pharmacologic profiles and potential therapeutic distinctions. Annals of Pharmacotherapy, 28, 13591369.
Fisher, S., Kent, T. A. & Bryant, S. G. (1995) Postmarketing surveillance by patient self-monitoring: preliminary data for sertraline versus fluoxetine. Journal of Clinical Psychiatry, 56, 288296.
Gagiano, C. A. (1993) A double-blind comparison of paroxetine and fluoxetine in patients with major depression. British Journal of Clinical Research, 4, 145152.
Garland, E. J., Remick, R. A. & Zis, A. P. (1988) Weight gain with antidepressants and lithium. Journal of Clinical Psychopharmacology, 8, 323330.
Geddes, J. R., Freemantle, N., Mason, J., et al (1999) SSRIs versus alternative antidepressants in depressive disorder. Cochrane Library, issue 4. Oxford: Update Software.
Gregor, K., Coons, S. J. & MacDonald, R. (1994) Selective serotonin reuptake inhibitor dose titration in a naturalistic setting. Clinical Therapeutics, 16, 306315.
Grimsley, S. R. & Jann, M. W. (1992) Paroxetine, sertraline, and fluvoxamine: new selective serotonin reuptake inhibitors. Clinical Pharmacy, 11, 930957.
Henry, J. A., Alexander, C. A. & Sener, E. K. (1995) Relative mortality from overdose of antidepressants. British Medical Journal, 310, 221224.
Hotopf, M., Lewis, G. & Normand, C. (1996) Are SSRIs a cost-effective alternative to tricyclics? British Journal of Psychiatry, 168, 404409.
Hylan, T. R., Dossenbach, M., Meneades, L., et al (1998a) Antidepressant use in the psychiatrist setting in Austria: a comparison of citalopram, fluoxetine, and paroxetine. Journal of Serotonin Research, 4, 295303.
Hylan, T. R., Dunn, R. L., Tepner, R., et al (1998b) Gaps in antidepressant prescribing in primary care in the United Kingdom. International Clinical Psychopharmacology, 13, 235243.
Hylan, T. R., Crown, W. H., Meneades, L., et al (1999a) SSRI antidepressant drug use patterns in the naturalistic setting. Medical Care, 37, AS36AS44.
Hylan, T. R., Meneades, L., Crown, W. H., et al (1999b) SSRI antidepressant use patterns and their relation to Clinical Global Impression scores: a naturalistic study. Journal of Affective Disorders, 52, 111119.
Isacsson, G., Boethius, G., Henriksson, S., et al (1999) Selective serotonin reuptake inhibitors have broadened the utilisation of antidepressant treatment in accordance with recommendations. Findings from a Swedish prescription database. Journal of Affective Disorders, 53, 1522.
Johnson, D. (1986) Noncompliance with antidepressant therapy – an underestimated problem. Internal Medicine, 11, 1417.
Johnson, D. A. W. (1973) Treatment of depression in general practice. British Medical Journal, i, 1820.
Johnson, D. A. W. (1981) Depression: treatment compliance in general practice. Acta Psychiatrica Scandinavica, 63 (suppl. 290), 447453.
Katon, W., von Korff, M., Lin, E., et al (1992) Adequacy and duration of antidepressant treatment in primary care. Medical Care, 30, 6776.
Katzelnick, D., Kobak, K. A., Jefferson, J., et al (1996) Prescribing patterns of antidepressant medications for depression in an HMO. Formulary, 31, 374388.
Keller, M. B., Klerman, G. L., Lavori, P. W., et al (1982) Treatment received by depressed patients. Journal of the American Medical Association, 248, 18481855.
Kotlin, J., Post, R. M. & Goodwin, F. K. (1973) Drug treatment of depressed patients referred for hospitalisation. American Journal of Psychiatry, 130, 11391141.
Kuzel, R. J., De Wester, J. N. & Richardson, F. (1996) Treating comorbid depression and anxiety. Journal of Family Practice, 43 (suppl. 6), S45S53.
Lejoyeux, M., Ades, J., Mourad, I., et al (1996) Antidepressant withdrawal syndrome recognition, prevention and management. CNS Drugs, 5, 278292.
Leonard, B. E. (1993) The comparative pharmacology of new antidepressants. Journal of Clinical Psychiatry, 15 (suppl. 3), 5458.
Lepine, J. P., Gastpar, M., Mendlewicz, J., et al (1997) Depression in the community: the first pan-European study DEPRES (Depression Research in European Society). International Clinical Psychopharmacology, 12, 1929.
Li, J., Claxton, A. J. & McKendrick, J. (1998) Antidepressant prescribing patterns and the risk of relapse and recurrence of depression in a primary care cohort in the United Kingdom. European Neuropsychopharmacology, 8 (suppl. 2), S166.
MacDonald, T. M., McMahon, A. D., Reid, I. C., et al (1996) Antidepressant drug use in primary care: a record linkage study in Tayside, Scotland. British Medical Journal, 313, 860861.
MacKay, F. R., Dunn, N. R., Wilton, L. V., et al (1997) A comparison of fluvoxamine, fluoxetine, sertraline and paroxetine examined by observational cohort studies. Pharmacoepidemiology and Drug Safety, 6, 235246.
MacKay, F. R., Dunn, N. R., Martin, R. M., et al (1999) Newer antidepressants: a comparison of tolerability in general practice. British Journal of General Practice, 49, 892896.
Maj, M., Veltro, F., Pirozzi, R., et al (1992) Pattern of recurrence of illness after recovery from an episode of major depression: a prospective study. American Journal of Psychiatry, 149, 795800.
McCombs, J. S., Nichol, M. B. & Stimmel, G. L. (1999) The role of SSRI antidepressants for treating depressed patients in the California Medicaid (Medi-Cal) program. Value in Health, 2, 269280.
Melfi, C. A., Chawla, A. J., Croghan, T. W., et al (1998) Effect of adherence to depression treatment guidelines on relapse and recurrence. Archives of General Psychiatry, 55, 11281132.
Michelson, D., Amsterdam, J. D., Quitkin, F. M., et al (1999) Changes in weight during a 1-year trial of fluoxetine. American Journal of Psychiatry, 156, 11701176.
Mintz, J., Mintz, L. I., Arruda, M. J., et al (1992) Treatments of depression and the functional capacity to work. Archives of General Psychiatry, 49, 761768.
Montejo, A. L., Gilaberte, I., Fombellida, C., et al (1998) Pattern of usage of new antidepressants in clinical practice. Actas Luso-Españolas de Neurologia, Psiquiatria y Ciencias Afines, 26, 7582.
Montgomery, S. A. & Kasper, S. (1995) Comparison of compliance between serotonin reuptake inhibitors and tricyclic antidepressants: a meta-analysis. International Clinical Psychopharmacology, 9 (suppl. 4), 3340.
Montgomery, S. A. & Kasper, S. (1998) Side effects, dropouts from treatment and cost consequences. International Clinical Psychopharmacology, 13 (suppl. 2), S1S5.
Montgomery, S. A., Rasmussen, J. G., Lyby, K., et al (1992) Dose response relationship of citalopram 20 mg, citalopram 40 mg and placebo in the treatment of moderate and severe depression. International Clinical Psychopharmacology, 6 (suppl. 5), 6570.
Montgomery, S. A., Henry, J., McDonald, G., et al (1994) Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. International Clinical Psychopharmacology, 9, 4753.
Munizza, C., Tibaldi, G., Bollini, P., et al (1995) Prescription pattern of antidepressants in out-patient psychiatric practice. Psychological Medicine, 25, 771778.
Murdoch, D. & McTavish, D. (1992) Sertraline. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive-compulsive disorder. Drugs, 44, 604624.
Navarro, R., Valler, W. E., Spangler, M., et al (1995) Antidepressant utilization in managed care: an evaluation of SSRI use in two HMO settings. Medical Interface, 8, 114123.
Nelson, J. C. (1997) Safety and tolerability of the new antidepressants. Journal of Clinical Psychiatry, 58 (suppl. 6), 2631.
Nemeroff, C. B. (1994) Evolutionary trends in the pharmacotherapeutic management of depression. Journal of Clinical Psychiatry, 55 (suppl. 12), 315.
Old Age Depression Interest Group (1993) How long should the elderly take antidepressants? A double-blind placebo-controlled study of continuation/prophylaxis therapy with dothiepin. British Journal of Psychiatry, 162, 175182.
Ontiveros, A. & Garcia-Barriga, C. (1997) Adouble-blind, comparative study of paroxetine and fluoxetine in out-patients with depression. British Journal of Clinical Research, 8, 2332.
Pande, A. C. & Sayler, M. E. (1993) Adverse events and treatment discontinuations in fluoxetine clinical trials. International Clinical Psychopharmacology, 8, 267269.
Parker, G. & Blennerhassett, J. (1998) Withdrawal reactions associated with venlafaxine. Australian and New Zealand Journal of Psychiatry, 32, 291294.
Patris, M., Bouchard, J. M., Bougerol, T., et al (1996) Citalopram versus fluoxetine: a double-blind, controlled, multicentre, phase III trial in patients with unipolar major depression treated in general practice. International Clinical Psychopharmacology, 11, 129136.
Paykel, E. S. & Priest, R. G. (1992) Recognition and management of depression in general practice: consensus statement. British Medical Journal, 305, 11981202.
Paykel, E. S., Mueller, P. S. & De la Vergne, P. M. (1973) Amitriptyline, weight gain and carbohydrate craving: a side effect. British Journal of Psychiatry, 123, 501507.
Phillips, S., Brent, J., Kulig, K., et al (1997) Fluoxetine versus tricyclic antidepressants: a prospective multicenter study of antidepressant drug overdoses. Journal of Emergency Medicine, 15, 439445.
Preskorn, S. H. (1995) Comparison of the tolerability of bupropion, fluoxetine, imipramine, nefazodone, paroxetine, sertraline, and venlafaxine. Journal of Clinical Psychiatry, 56(suppl. 6), 1221.
Price, J. S., Waller, P. C., Wood, S. M., et al (1996) A comparison of the post-marketing safety of four selective serotonin re-uptake inhibitors including the investigation of symptoms occurring on withdrawal. British Journal of Clinical Pharmacology, 42, 757763.
Prien, R. F. & Kupfer, D. J. (1986) Continuation drug therapy for major depressive episodes: how long should it be maintained? American Journal of Psychiatry, 143, 1823.
Reimherr, F. W., Byerley, W. F., Ward, M. F., et al (1988) Sertraline, a selective inhibitor of serotonin uptake, for the treatment of out patients with major depressive disorder. Psychopharmacology Bulletin, 24, 200205.
Reimherr, F. W., Chouinard, G., Cohn, C. K., et al (1990) Antidepressant efficacy of sertraline: adouble-blind, placebo— and amitriptyline-controlled multicenter comparison study in outpatients with major depression. Journal of Clinical Psychiatry, 51 (suppl B), 1827.
Reimherr, F. W., Amsterdam, J. D., Quitkin, F. M., et al (1998) Optimal length of continuation therapy in depression: a prospective assessment during long-term fluoxetine treatment. American Journal of Psychiatry, 155, 12471253.
Rickels, K. & Schweizer, E. (1990) Clinical overview of serotonin reuptake inhibitors. Journal of Clinical Psychiatry, 51 (12, suppl. B), 912.
Rosen, R. C., Lane, R. M. & Menza, M. (1999) Effects of SSRIs on sexual function: a critical review. Journal of Clinical Psychopharmacology, 19, 6785.
Rosenbaum, J., Fava, M., Hoog, S. L., et al (1998) Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial. Biological Psychiatry, 44, 7787.
Rosholm, J. U., Hallas, J. & Gram, L. F. (1993) Outpatient utilization of antidepressants: a prescription database analysis. Journal of Affective Disorders, 27, 2128.
Rudolph, R. L., Entsuah, R. & Chitra, R. (1998) A meta-analysis of the effects of venlafaxine on anxiety associated with depression. Journal of Clinical Psychiatry, 59, 116122.
Schatzberg, A. F., Haddad, P., Kaplan, E. M., et al (1997) Serotonin reuptake inhibitor discontinuation syndrome: a hypothetical definition. Discontinuation Consensus Panel. Journal of Clinical Psychiatry, 58 (suppl. 7), 510.
Sclar, D. A., Robison, L. M., Skaer, T. L., et al (1994) Antidepressant pharmacotherapy: economic outcomes in ahealth maintenance organization. Clinical Therapeutics, 16, 715730.
Sclar, D. A., Robison, L. M., Skaer, T. L., et al (1995) Antidepressant pharmacotherapy: economic evaluation of fluoxetine, paroxetine and sertraline in a health maintenance organization. Journal of International Medical Research, 23, 395412.
Scott, J. (1988) Chronic depression. British Journal of Psychiatry, 153, 287297.
Simon, G. E., Wagner, E. & Von Korff, M. (1995) Cost-effectiveness comparisons using real-world randomized trials: the case of new antidepressant drugs. Journal of Clinical Epidemiology, 48, 363373.
Simon, G. E., Von Korff, M., Heiligenstein, J. H., et al (1996) Initial antidepressant choice in primary care: effectiveness and cost of fluoxetine vs. tricyclic antidepressants. Journal of the American Medical Association, 275, 18971902.
Song, F., Freemantle, N., Sheldon, T. A., et al (1993) Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. British Medical Journal, 306, 683687.
Sturm, R. & Wells, K. B. (1995) How can care for depression become more cost-effective? Journal of the American Medical Association, 273, 5158.
Thompson, C. & Thompson, C. M. (1989a) The prescription of antidepressants in general practice. I: A critical review. Human Psychopharmacology, 4, 91107.
Thompson, C. & Thompson, C. M. (1989b) Prescribing of antidepressants in general practice. II: A placebo controlled trial of low dose dothiepin. Human Psychopharmacology, 4, 191204.
Thompson, C., Peveler, R. C., Stephenson, D., et al (2000) Compliance with antidepressant medication in the treatment of major depressive disorder in primary care: a randomized comparison of fluoxetine and a tricyclic antidepressant. American Journal of Psychiatry, 157, 338343.
Tignol, J. (1993) A double-blind, randomized, fluoxetine-controlled, multicenter study of paroxetine in the treatment of depression. Journal of Clinical Psychopharmacology, 13 (6, suppl. 2), 18S22S.
Treglia, M., Neslusan, C. A. & Dunn, R. L. (1999) Fluoxetine and dothiepin therapy in primary care and health resource utilization: evidence from the United Kingdom. International Journal of Psychiatry in Clinical Practice, 3, 2330.
Truter, I. & Kotze, T. J. (1996) An investigation into the prescribing patterns of selective serotonin reuptake inhibitors in South Africa. Journal of Clinical Pharmacy and Therapeutics, 21, 237242.
Wernicke, J. F., Bosomworth, J. C. & Ashbrook, E. (1989) Fluoxetine at 20 mg per day: the recommended and therapeutic dose in the treatment of depression. International Clinical Psychopharmacology, 4 (suppl. 1), 6367.
World Health Organization Mental Health Collaborating Centers (1989) Pharmacotherapy of depressive disorders: WHO consensus statement. Journal of Affective Disorders, 17, 197198.
Zajecka, J., Amsterdam, J. D., Quitkin, F. M., et al (1999) Changes in adverse events reported by patients during six months of fluoxetine therapy. Journal of Clinical Psychiatry, 60, 389394.
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Antidepressant use in clinical practice: efficacy v. effectiveness

  • John Donoghue (a1) and Timothy R. Hylan (a2)
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