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New NICE guidance on the treatment of generalised anxiety disorder (GAD) and panic disorder (with or without agoraphobia)

In January, the National Institute for Health and Clinical Excellence (NICE) published their new evidence-based clinical guideline on the care and treatment of adults with generalised anxiety disorder (GAD) or panic disorder (with or without agoraphobia).  This guideline updates and replaces their 2004 one (which was itself amended in 2007).  The full 56 page guideline is available as a PDF and in Word format.  It also comes as a 24 page "Quick reference guide" for health professionals, and as a 16 page "Treating generalised anxiety disorder and pan

Recent research: six studies on depression - adolescents, heart disease, telephone management, memories, & primary care

Here are half a dozen recent research papers on depression (all details & abstracts to these studies are listed further down this blog post).  The first two are about the well-known Treatment for Adolescents with Depression Study (TADS).  There have been a whole series of research papers published on this large multisite US National Institute of Mental Health funded study.  For more information click on the TADS home page.  The study compared CBT, fluoxetine, or their combination in treating moderate to severe depression in teenagers.  As March & Vitiello state in their overview "Findings revealed that 6 to 9 months of combined fluoxetine plus CBT should be the modal treatment from a public health perspective as well as to maximize benefits and minimize harms for individual patients ...

“Antidepressants are not all created equal”

Cipriani and colleagues published a major multiple-treatments meta-analysis of new generation antidepressants last week - see abstract below.  As Parikh wrote in his linked editorial (see below) "Andrea Cipriani and colleagues provide the field with a major answer.  Free of any potential funding bias (and including an analysis of studies based on pharmaceutical-company sponsorship), these researchers used a newer methodology, multiple treatments meta-analysis, to examine 117 head-to-head randomised trials in almost 26 000 patients ... Of 12 newer antidepressants, four emerged as superior in efficacy: escitalopram, mirtazapine, sertraline, and venlafaxine ... In terms of acceptability, four agents were better tolerated: bupropion, citalopram, escitalopram, and sertraline.  Balancing efficacy and acceptability and lower drug costs, the researchers concluded that sertraline might be particularly appropriate as a first-choice treatment ... "  This is superbly useful information.  Parikh's editorial goes on to raise helpful queries about next step questions, however Cipriani et al have done antidepressant prescribers and users a major service with this very important paper.

Some interesting articles from February ‘08

Here are details and links for a couple of dozen mainly February articles that I found interesting. Most of these articles (and many others) are also listed on my searchable Connotea online database.

Barbui, C. M. D., T. A. M. D. Furukawa, et al. (2008). "Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials." CMAJ 178(3): 296-305. [Abstract/Full Text]
Blakely, T., M. Tobias, et al. (2008). "Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies." BMJ 336(7640): 371-375. [Abstract/Full Text]
Bradley, R. G., E. B. Binder, et al. (2008). "Influence of Child Abuse on Adult Depression: Moderation by the Corticotropin-Releasing Hormone Receptor Gene." Arch Gen Psychiatry 65(2): 190-200. [Abstract/Full Text]

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