Hitoshi Sakurai1, Hiroyuki Uchida2, Masaki Kato3, Takefumi Suzuki4, Hajime Baba5, Koichiro Watanabe6, Ken Inada7, Toshiaki Kikuchi2, Asuka Katsuki8, Ikuko Kishida9, Yuka Sugawara Kikuchi10, Norio Yasui-Furukori11. 1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. 2. Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. 3. Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan. 4. Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan. 5. Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan. 6. Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan. 7. Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo Japan. 8. Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan. 9. Fujisawa Hospital, Kanagawa, Japan; Department of Psychiatry, Yokohama City University School of Medicine, Kanagawa, Japan. 10. Department of Psychiatry, Akita University School of Medicine, Akita, Japan. 11. Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan. Electronic address: furukori@dokkyomed.ac.jp.
Abstract
BACKGROUND: Clinically relevant issues in the real-world treatment of depression have not always been captured by conventional treatment guidelines. METHODS: Certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology were asked to evaluate treatment options regarding 23 clinical situations in the treatment of depression using a 9-point Likert scale (1="disagree" and 9="agree"). According to the responses of 114 experts, the options were categorized into first-, second-, and third-line treatments. RESULTS: First-line antidepressants varied depending on predominant symptoms: escitalopram (mean ± standard deviation score, 7.8 ± 1.7) and sertraline (7.3 ± 1.7) were likely selected for anxiety; duloxetine (7.6 ± 1.9) and venlafaxine (7.2 ± 2.1) for loss of interest; mirtazapine for insomnia (8.2 ± 1.6), loss of appetite (7.9 ± 1.9), agitation and severe irritation (7.4 ± 2.0), and suicidal ideation (7.5 ± 1.9). While first-line treatment was switched to either an SNRI (7.7 ± 1.9) or mirtazapine (7.4 ± 2.0) in the case of non-response to an SSRI, switching to mirtazapine (7.1 ± 2.2) was recommended in the case of non-response to an SNRI, and vice versa (switching to an SNRI (7.0 ± 2.0) in the case of non-response to mirtazapine). Augmentation with aripiprazole was considered the first-line treatment for partial response to an SSRI (7.1 ± 2.3) or SNRI (7.0 ± 2.5). LIMITATIONS: The evidence level of expert consensus is considered low. All included experts were Japanese. CONCLUSIONS: Recommendations made by experts in the field are useful and can supplement guidelines and informed decision making in real-world clinical practice. We suggest that pharmacological strategies for depression be flexible and that each patient's situational needs as well as the pharmacotherapeutic profile of medications be considered.
BACKGROUND: Clinically relevant issues in the real-world treatment of depression have not always been captured by conventional treatment guidelines. METHODS: Certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology were asked to evaluate treatment options regarding 23 clinical situations in the treatment of depression using a 9-point Likert scale (1="disagree" and 9="agree"). According to the responses of 114 experts, the options were categorized into first-, second-, and third-line treatments. RESULTS: First-line antidepressants varied depending on predominant symptoms: escitalopram (mean ± standard deviation score, 7.8 ± 1.7) and sertraline (7.3 ± 1.7) were likely selected for anxiety; duloxetine (7.6 ± 1.9) and venlafaxine (7.2 ± 2.1) for loss of interest; mirtazapine for insomnia (8.2 ± 1.6), loss of appetite (7.9 ± 1.9), agitation and severe irritation (7.4 ± 2.0), and suicidal ideation (7.5 ± 1.9). While first-line treatment was switched to either an SNRI (7.7 ± 1.9) or mirtazapine (7.4 ± 2.0) in the case of non-response to an SSRI, switching to mirtazapine (7.1 ± 2.2) was recommended in the case of non-response to an SNRI, and vice versa (switching to an SNRI (7.0 ± 2.0) in the case of non-response to mirtazapine). Augmentation with aripiprazole was considered the first-line treatment for partial response to an SSRI (7.1 ± 2.3) or SNRI (7.0 ± 2.5). LIMITATIONS: The evidence level of expert consensus is considered low. All included experts were Japanese. CONCLUSIONS: Recommendations made by experts in the field are useful and can supplement guidelines and informed decision making in real-world clinical practice. We suggest that pharmacological strategies for depression be flexible and that each patient's situational needs as well as the pharmacotherapeutic profile of medications be considered.
Authors: Carmen Galán-Arroyo; Damián Pereira-Payo; Jorge Rojo-Ramos; Miguel A Hernández-Mocholí; Eugenio Merellano-Navarro; Jorge Pérez-Gómez; Ángel Denche-Zamorano; Jose Carmelo Adsuar Journal: Int J Environ Res Public Health Date: 2022-02-28 Impact factor: 3.390