title: Use of antidepressants in the treatment of depression in Asia: guidelines, clinical evidence, and experience revisited.
abstract: Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence-based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence-based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients.
authors.affiliation: Neuroscience Research, Eli Lilly and Company, Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Treuer
authors.forename: Chia-Yih
authors.initials: CY
authors.lastname: Liu
authors.forename: Gerardo
authors.initials: G
authors.lastname: Salazar
authors.forename: Ronnachai
authors.initials: R
authors.lastname: Kongsakon
authors.forename: Fujun
authors.initials: F
authors.lastname: Jia
authors.forename: Hussain
authors.initials: H
authors.lastname: Habil
authors.forename: Min-Soo
authors.initials: MS
authors.lastname: Lee
authors.forename: Amanda
authors.initials: A
authors.lastname: Lowry
authors.forename: Héctor
authors.initials: H
authors.lastname: Dueñas
mesh_terms: D000928:Antidepressive Agents / Q000145:classification / Q000191:economics / Q000627:therapeutic use*; D001208:Asia; D032921:Consensus; D003431:Cross-Cultural Comparison; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D055502:Secondary Prevention
chemical_list: D000928:Antidepressive Agents
keywords: Asia; antidepressive agent; depressive disorder; duloxetine; guideline