The effectiveness of SSRIs on depression in primary care

Abstract

Depression is the fourth ranking condition in terms of burden on the healthcare system with most of the sufferers middle-aged adults, treated in primary care. Although SSRis, a class of antidepressants, are often the treatment of choice, however, their efficacy and safety are still being questioned. Hence the research question is; "What are the efficacy and safety( outcome) of SSRis (intervention) in middle-aged adults diagnosed with depression in primary care (population), when compared to a placebo (control)?" Studies which fit the PICO question and ranked highest in the hierarchy of evidence were included. Studies also had to be published in English within the time frame of 2001-2012. Outcomes considered were depression scores as a measurement of efficacy and incidence of adverse events, including suicide, suicidal thoughts and self-harm. After these inclusion and exclusion criteria were used 2 meta-analyses, 1 systematic review and a RCT were selected. Critical Appraisal Skills Programme (CASP) tools were used to appraise retrieved literature. The methodology used by the studies reviewed was critically appraised in order to identify the possible positive and negative outcomes related to it as well as any sources of error or bias. The studies reviewed concluded that SSRis are effective when compared to a placebo in the treatment of depression in primary care. Different SSRis were associated with different levels of efficacy. Nevertheless, SSRis are also related to a possible increase in the incidence of suicide, suicidal thoughts and non-fatal self harm. Thus it is recommended that education of healthcare professionals and the public is vital in promoting awareness when it comes to the use of SSRis in primary care. This should address safety issues related to SSRis including any common side-effects. Also, there is a need for more research in the area with larger sample sizes and longer duration of treatment.