DEPRESSION IN PRIMARY-CARE - REVIEW OF AHCPR GUIDELINES

OBJECTIVE: TO present an overview and evaluation of the Agency for Hea lth Care Policy and Research (AHCPR) clinical practice guidelines for the treatment of depression. INTRODUCTION: One responsibility of the A HCPR is the development and periodic review and update of clinical pra ctice guidelines. This process is undertaken by an independent panel c omposed of groups of clinicians and other experts from the private sec tor. Their findings are published in a four-volume, softcover set of b ooklets. DATA SOURCE AND EVALUATION: Volume 2 in the four-volume set i ncludes a comprehensive compilation, synthesis, and critical evaluatio n of the studies of different treatments for depression. Studies inclu ded for evaluation were randomized, prospective clinical trials that w ere pertinent to all topics concerning the treatment of depression. In some areas, the opinions of the panel were included due to a paucity of data from well-controlled clinical trials. Each AHCPR guideline was followed by a code that indicated whether the strength of evidence su pporting that guideline was based on good or fair research-based evide nce, or whether it was based primarily on panel members' opinions. CON CLUSIONS: With regard to drug treatment, the guidelines are good. Howe ver, since these guidelines were published in 1993 they might be consi dered somewhat dated because more antidepressants have become availabl e in the interim. Overall, the AHCPR guidelines reflect an extensive r eview of the literature provided by the panel, as well as input from a highly respected group of reviewers. The panel included physicians, a nurse, a social worker, a psychologist, and a consumer representative . Unfortunately, a pharmacist was not included on the panel. Input fro m pharmacy practitioners would have been valuable.