Antidepressant use in clinical practice: efficacy v. effectiveness

Background Although the efficacy of antidepressants has been demonstrated i n randomised, controlled clinical trials, it is how an antidepressant is us ed in clinical practice that determines its clinical effectiveness, or real -world efficacy. Aims To explore the frequency with which antidepressants are used at adequa te dose and duration to obtain remission of symptoms and prevent relapse in clinical practice and discuss potential implications for clinical outcomes . Method Studies of antidepressant prescribing were reviewed and comparisons made between antidepressant classes and individual compounds within those c lasses. Results Naturalistic studies show that patients who begin therapy on tricyc lic antidepressants often receive sub-therapeutic doses for inadequate dura tion; conversely, patients who begin therapy on selective serotonin reuptak e inhibitors more often receive an adequate dose of therapy for a longer du ration. Conclusions How antidepressants are used in clinical practice can determine the clinical outcomes that are achieved, Antidepressants that are more for giving of sub-optimal prescribing and use patterns by providers and patient s, respectively, may help to improve real-world efficacy. Declaration of interest J.D. received an honorarium and travel expenses fro m Eli Lilly & Co. At the time of manuscript preparation, T.R.H. was employe d at Eli Lilly & Co.