Seetal Dodd1,2,3,4, Philip B Mitchell5, Michael Bauer6, Lakshmi Yatham7, Allan H Young8, Sidney H Kennedy9, Lana Williams1, Trisha Suppes10, Carlos Lopez Jaramillo11, Madhukar H Trivedi12, Maurizio Fava13, A John Rush14, Roger S McIntyre9,15,16, Michael E Thase17, Raymond W Lam7, Emanuel Severus6, Siegfried Kasper18, Michael Berk1,2,3,4,19. 1. a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia. 2. b Department of Psychiatry , University of Melbourne , Melbourne , Australia. 3. c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia. 4. d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia. 5. f School of Psychiatry , University of New South Wales, and Black Dog Institute , Sydney , Australia. 6. g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany. 7. h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada. 8. i Department of Psychological Medicine , Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK & South London and Maudsley NHS Foundation Trust , London , UK. 9. j Department of Psychiatry , University of Toronto , Toronto , ON , Canada. 10. k Department of Psychiatry & Behavioral Sciences , School of Medicine, Stanford University , Stanford , CA , USA. 11. l Department of Psychiatry , Universidad de Antioquia , Medellín , Colombia. 12. m Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA. 13. n Division of Clinical Research , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA. 14. o Duke-National University of Singapore Medical School , Singapore , Singapore. 15. p Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , ON , Canada. 16. q Brain and Cognition Discovery Foundation , Toronto , ON , Canada. 17. r Department of Psychiatry, Perelman School of Medicine , University of Pennsylvania , Pennsylvania , PA , USA. 18. s Department of Psychiatry and Psychotherapy , Medical University of Vienna , Wien , Austria. 19. e The Florey Institute of Neuroscience and Mental Health , Parkville , Australia.
Abstract
OBJECTIVES: These recommendations were designed to ensure safety for patients with major depressive disorder (MDD) and to aid monitoring and management of adverse effects during treatment with approved antidepressant medications. The recommendations aim to inform prescribers about both the risks associated with these treatments and approaches for mitigating such risks. METHODS: Expert contributors were sought internationally by contacting representatives of key stakeholder professional societies in the treatment of MDD (ASBDD, CANMAT, WFSBP and ISAD). The manuscript was drafted through iterative editing to ensure consensus. RESULTS: Adequate risk assessment prior to commencing pharmacotherapy, and safety monitoring during pharmacotherapy are essential to mitigate adverse events, optimise the benefits of treatment, and detect and assess adverse events when they occur. Risk factors for pharmacotherapy vary with individual patient characteristics and medication regimens. Risk factors for each patient need to be carefully assessed prior to initiating pharmacotherapy, and appropriate individualised treatment choices need to be selected. Some antidepressants are associated with specific safety concerns which were addressed. CONCLUSIONS: Risks of adverse outcomes with antidepressant treatment can be managed through appropriate assessment and monitoring to improve the risk benefit ratio and improve clinical outcomes.
OBJECTIVES: These recommendations were designed to ensure safety for patients with major depressive disorder (MDD) and to aid monitoring and management of adverse effects during treatment with approved antidepressant medications. The recommendations aim to inform prescribers about both the risks associated with these treatments and approaches for mitigating such risks. METHODS: Expert contributors were sought internationally by contacting representatives of key stakeholder professional societies in the treatment of MDD (ASBDD, CANMAT, WFSBP and ISAD). The manuscript was drafted through iterative editing to ensure consensus. RESULTS: Adequate risk assessment prior to commencing pharmacotherapy, and safety monitoring during pharmacotherapy are essential to mitigate adverse events, optimise the benefits of treatment, and detect and assess adverse events when they occur. Risk factors for pharmacotherapy vary with individual patient characteristics and medication regimens. Risk factors for each patient need to be carefully assessed prior to initiating pharmacotherapy, and appropriate individualised treatment choices need to be selected. Some antidepressants are associated with specific safety concerns which were addressed. CONCLUSIONS: Risks of adverse outcomes with antidepressant treatment can be managed through appropriate assessment and monitoring to improve the risk benefit ratio and improve clinical outcomes.
Entities:
Keywords:
Antidepressants; adverse effects; evidence-based guidelines; major depressive disorder; pharmacotherapy
Authors: Rachael W Taylor; Lindsey Marwood; Emanuella Oprea; Valeria DeAngel; Sarah Mather; Beatrice Valentini; Roland Zahn; Allan H Young; Anthony J Cleare Journal: Int J Neuropsychopharmacol Date: 2020-12-03 Impact factor: 5.176