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Guidelines for precribing antidepressant drugs

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  • Ian Pitchford
    FOR RELEASE: 1 MAY 2000 AT 17:00 ET US American College of Physicians-American Society of Internal Medicine http://www.acponline.org/ ACP-ASIM issues
    Message 1 of 1 , May 2, 2000
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      FOR RELEASE: 1 MAY 2000 AT 17:00 ET US
      American College of Physicians-American Society of Internal Medicine
      http://www.acponline.org/

      ACP-ASIM issues guidelines for precribing antidepressant drugs

      New guidelines for drug treatment of depression, released today by the
      American College of Physicians-American Society of Internal Medicine
      (ACP-ASIM), say that both older and newer antidepressant drugs are effective,
      and that St. John's wort may be effective in treating mild depression in the
      short term, but with caveats. "Depression strikes all ages, races, and income
      brackets. It's a very painful but very treatable illness, and there are many
      options available. It's important to talk to your doctor to determine the
      treatment that's best for you," says Herbert H. Waxman, MD, ACP-ASIM senior
      vice president for education.

      To expedite doctor-patient discussions about depression, ACP-ASIM has
      developed a patient education brochure that is available by calling
      1-877-828-2525. The information is also available on an ACP-ASIM Web site:
      www.doctorsforadults.com.

      The guidelines, "Pharmacologic Treatment of Acute Major Depression and
      Dysthymia," and a background paper, "A Systematic Review of Newer
      Pharmacotherapies for Depression in Adults: Evidence Report Summary," are
      published in the May 2 issue of Annals of Internal Medicine.

      The older drugs for treating major depression, such as tricyclics, and the
      newer drugs, such as selective serotonin reuptake inhibitors (SSRIs), have
      different side effects, interactions and costs. Patients taking tricyclics
      need dosage monitoring, and tricyclics can be fatal in overdoses. Tricyclics,
      most of which are available generically, are cheaper per pill. SSRIs and
      other newer drugs are not currently available in generic form and are
      generally more expensive. SSRIs are easier to take and do not require blood
      testing. Physicians should discuss with patients the uses and side effects of
      appropriate drugs, the guidelines say, and together, doctor and patient
      should come up with an antidepressant that fits the patient's needs.

      ACP-ASIM recommendations about St. John's wort come with warnings. St. John's
      wort studies were mostly done in Europe. In the U.S., St. John's wort is sold
      as a dietary supplement, not as a drug, and therefore is not regulated by the
      FDA. The bottle labels can be misleading. The amounts of active St. John's
      wort ingredients vary in these supplements, and the pills often contain
      additional substances. Studies show that St. John's wort is better than
      placebo (a fake pill), but there are no good studies comparing St. John's
      wort directly with antidepressant drugs. Finally, St. John's wort has side
      effects, may interfere seriously with blood thinners and other important
      medications, and it should never be taken with other antidepressant drugs.

      "We'll have to see more evidence-based studies on St. John's wort," says
      Waxman. "Meanwhile, if you are taking St. John's wort or any herbal
      supplement, let your doctor know."

      While ACP-ASIM's new guidelines address drug treatment, depression can be
      treated in other ways, Waxman says. "Our guidelines are aimed at helping
      internists, together with their adult patients, make informed choices about
      treating depression with antidepressant drugs and herbal therapies."

      The guidelines are appropriate for adult patients with no other medical
      conditions. ACP-ASIM did not find sufficient evidence to make recommendations
      for treatment of depression in adolescents or to treat other depressive
      disorders.

      ACP-ASIM is a professional organization representing 115,000 internists,
      doctors for adults, and is the second largest medical organization in the
      U.S. It has been issuing evidence-based clinical practice guidelines for 20
      years.



      The article, "Pharmacologic Treatment of Acute Major Depression and
      Dysthymia" and background paper, "A Systematic Review of Newer
      Pharmacotherapies for Depression in Adults: Evidence Report Summary," are
      available on the Web at www.annals.org. , on May 2, 2000

      The Agency for Health Quality Research report, "Treatment of Depression:
      Newer Pharmacotherapies" Evidence Report/Technical Assessment No. 7, Agency
      for Health Care Policy and Research; Feb. 1999. AHCPR Publication No. 99-E014
      , can be obtained from the Agency for Health Quality Research or is available
      on the AHQR Web site:
      http://text.nlm.nih.gov/ftrs/pick?collect=epc&dbName=dep&cd=1&t=956241237
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