Which antidepressant? A commentary from general practice on evidence-based medicine and health economics.

Abstract

BACKGROUND: With increasing demand for health care, evidence-based medicine combined with health economics offers a method of optimizing allocation of limited resources. Depression is an illness that has a high prevalence with important medical, social and economic implications. More than 90% of depression is diagnosed and treated in general practice. AIM: To review the effectiveness of an evidence-based approach combined with health economics in deciding whether a tricyclic antidepressant (TCA) or a selective serotonin reuptake inhibitor (SSRI) should be used in the treatment of depression in general practice. METHOD: An evidence-based strategy tested the two treatments against the criteria of appropriateness, efficacy, effectiveness and value for money. RESULTS: Although both drugs were equally efficacious, their relative effectiveness and value for money could not be accurately defined. CONCLUSION: An evidence-based approach does not make clear whether SSRIs or TCAs should be used for the treatment of depression in general practice. Research questions arising from general practice should be addressed in a relevant setting and should yield answers that will complement and support a more pragmatic system of medicine rather than seek to direct it.