Treatment of unipolar psychotic depression: the use of evidence in practice guidelines.
BACKGROUND
In a recent meta-analysis we found no evidence that an antidepressant plus an antipsychotic is more effective than an antidepressant alone in unipolar psychotic depression. However, most current guidelines recommend the combination over an antidepressant alone.


METHODS
We assessed available guidelines by the AGREE instrument and discuss their recommendations in relation to the evidence as referred to in the guidelines.


RESULTS
The UK-NICE guideline had the highest AGREE quality score, followed by the Dutch, Australian, and US-APA guidelines. Guidelines are not always consistent with at date of publication available evidence and (with exception of the UK-NICE and Dutch guidelines) also not with the in that guideline referred evidence.


CONCLUSIONS
Physicians (and patients) should be aware that in guidelines treatment recommendations may be less evidence-based than asserted, even when treatment recommendations are stated as being based on the highest level of evidence.
Wijkstra
Jaap
J
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands. j.wijkstra@umcutrecht.nl
Schubart
Chris D
CD
Nolen
Willem A
WA
D000341:Affective Disorders, Psychotic / Q000188:drug therapy*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D003431:Cross-Cultural Comparison; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D014481:United States
D000928:Antidepressive Agents; D014150:Antipsychotic Agents