Linden M, Schotte K
Research Group Psychosomatic Rehabilitation at the Charité, University Medical School, Berlin, Germany.
Pharmacopsychiatry. 2007 Mar;40(2):77-81. doi: 10.1055/s-2007-972574.
Can prescribing of insufficient dosages and outcome of treatment with antidepressants in routine care be improved by guidelines?
161 general practitioners and 162 psychiatrists in private practice documented 1319 patients, receiving doxepin for individual clinical reasons. Physicians were randomly divided into a guideline exposed and a control group. All physicians treated their patients according to individual clinical considerations.
Average maximum daily dosage was 83 mg/d in the control and 95 mg/d in the intervention group (F=19.15; p<0). Only 3% of patients in both groups got the recommended dosage of 150 mg/d. Guideline exposure resulted in increased dosages preferably for milder forms of depression and in comparatively lower rates of improvement.
Guideline exposure did not reach its goal in respect to the recommended dosage. It missed its goal in respect to improvement of outcome and even showed negative effects. Guidelines should be evidence-based not only by referring to literature reviews but by testing their clinical effects in controlled clinical trials.
指南能否改善常规护理中抗抑郁药剂量不足的处方情况及治疗效果？
161名全科医生和162名私人执业精神科医生记录了1319名因个体临床原因接受多塞平治疗的患者。医生被随机分为接受指南组和对照组。所有医生均根据个体临床考虑对患者进行治疗。
对照组的平均最大日剂量为83毫克/天，干预组为95毫克/天（F = 19.15；p < 0）。两组中只有3%的患者达到了推荐剂量150毫克/天。接受指南导致剂量增加，这在轻度抑郁症患者中更为明显，但改善率相对较低。
在推荐剂量方面，接受指南并未达到目标。在改善治疗效果方面也未达到目标，甚至显示出负面影响。指南不仅应通过参考文献综述以循证为基础，还应通过在对照临床试验中测试其临床效果。
