Important to know

  • In the subgroup of light and medium depressions (or, moreover, only the lungs) differences between antidepressants in the value of Response Rate and speed of onset of effect is even smaller than the unfiltered by the criterion of the severity of the general population of depressed patients (including patients with severe depression, as you know, a minority). In these subgroups there is a higher percentage of spontaneous remissions occurring even without treatment and just coincided with the start of treatment.
  • In these subgroups there is much more pronounced placebo effect (Placebo Response Rate), to the extent that, in some trials, it was shown that the light and very light depressions BP generally inefficient, to be exact – are no more effective than placebo. Especially if you carry out filtering also the primacy of the criterion, that is to consider only the primary, previously untreated patients, patients with a first episode of depression in my life.
  • However, the situation changes if we consider only the subgroup of patients with severe and very severe depression and / or sub-group of patients with recurrent depression, with many years of depressive history, not primary (formerly lechёnyh, whether successfully or unsuccessfully), and the more patients with some degree of treatment resistance (therapeutic failures on various antidepressants in history).
  • In this subgroup, and the percentage of spontaneous remission is very low in the short term (usually for such a study design), and the placebo effect is much weaker, and the effect of antidepressants is expressed more clearly, more clearly, more noticeable (greater difference from placebo) than in the subgroup of light depressions.
  • In this same subgroup revealed a statistically significant and significant differences in Response Rate at different pharmacological classes of antidepressants: tricyclic antidepressants (TCAs) and “dual-action antidepressants” (SIOZSiN) are significantly more effective than SSRIs, bupropion, and others.
  • Statistically significant differences were detected in several other samples, for example, in depression with chronic pain antidepressants have analgesic activity (TCAs SIOZSiN) again outperform antidepressants, such activity is not. When depression, comorbid with OCD, antidepressants are effective only having antiobsessivnye activity (clomipramine, SIOZSiN SSRIs).
  • When depression, comorbid panic disorder, generalized anxiety disorder, social phobia, it is important the presence of proven antidepressant anxiolytic / antipanic / antifobicheskoy activity (bupropion, for example, does not work in anxiety disorders, have TCAs not shown activity in social phobia).
  • Also, the picture is “all antidepressants about equally effective” change if we toughen the criteria for what constitutes a “response to therapy”, and set as a criterion not Response Rate (usually defined as> 50% at best, and even 25% reduction on a scale of HAM-D), and Remission Rate (the percentage of complete remission, the disappearance of all symptoms of depression). That is when we begin to attach importance not only to the fact of response to therapy, but DEPTH reduction depressive syndrome.
  • And here it turns out that even in the general population, not on the specific sample (that is, even if you do not exclude light and medium depression and primary, previously untreated patients), tricyclic antidepressants and SIOZSiN significantly more effective than SSRIs – more depth reduction of depressive syndrome, greater percentage It is in complete remission.
  • And there are two more specific therapeutically relevant subgroups of depressed patients who require specific therapeutic approaches.