Magazine article Drug Topics

New Treatment Guidelines for Depression Coming

Magazine article Drug Topics

New Treatment Guidelines for Depression Coming

Article excerpt

New methods for analyzing depression are on the way. An upcoming decision tree for pharmacoeconomic analysis of depression treatment will offer separate, detailed analyses for primary care and for psychiatric treatment. Also on the way are treatment guidelines from the American Pharmaceutical Association and treatment algorithms from the Texas Medication Algorithm Project (TMAP).

Although the terms guideline and decision tree are sometimes used interchangeably, there are differences. While guidelines are statements of policy or procedure, decision trees are similar to algorithms, which offer step-by-step procedures for solving problems. According to Larry Ereshefsky, Pharm.D., professor of psychiatry and pharmacology at the University of Texas Health Science Center at San Antonio, while economic analysis has a place in clinical treatment guidelines or algorithms, "our cost-estimation decision tree models actual practice conditions. Unlike treatment algorithms, we don't tell people what to do," he said. TMAP is funded by federal and private monies to produce and study effects of treatment algorithms in the public mental health sector.

For instance, venlafaxine (Effexor, Wyeth-Ayerst) studies suggest that higher doses may produce a better response in some patients, but no pharmacoeconomic research confirms the economic value of this effect. With the decision tree, a health-care professional can see how a higher dose and even subtly better efficacy would influence costs, including a wide range of economic variables beyond direct costs.

TMAP cochair M. Lynn Crismon, Pharm.D., pointed out that even just the pharmacoeconomic analysis may vary among models, if only because of different basic definitions of terms such as indirect cost.

Ereshefsky's model explores the hypothesis that significant long-term economic consequences can result from even the subtle clinical differences that are seen from discontinuations, switches, relapses, and remissions. …

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