What are the indications for prescribing antidepressants that will lead to a clinical benefit?There were 36m prescriptions for an antidepressant in 2009. There is still much uncertainty about when people with depression might benefit from antidepressant medication and concern that they are prescribed when it is not really necessary. The overall objective of the programme is to provide general practitioners with a structured assessment and clinical algorithm that will enable them to make recommendations about the likely response to selective serotonin reuptake inhibitor (SSRI) antidepressants for patients with depression in primary care. Before we can carry out a definitive randomised trial to answer this question, we also plan to use existing data to get an estimate of the likely threshold and to “map” the different questionnaires used to assess depression so that we can interpret the previous results. We also need to estimate a meaningful clinical difference in this population so that we know what size of difference is worth investigating and the way that participants answer questions on the questionnaires that are used. Once these have been established we can plan and carry out the randomised controlled trial.
Our hypothesis is that the severity and duration of depressive symptoms is related to antidepressant response though the main aim will be to establish the thresholds on severity and duration that will indicate likely benefit of antidepressants. We will use a self-administered computerised assessment so the results can be implemented easily within primary care.