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


OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Kernick
D P
DP
St Thomas Medical Group, Exeter.
D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D004739:England; D019317:Evidence-Based Medicine; D005194:Family Practice; D017048:Health Care Costs; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors