Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
J Affect Disord. 2011 Aug;132 Suppl 1:S3-8. doi: 10.1016/j.jad.2011.03.045. Epub 2011 May 10.
In an era of contention about the efficacy of antidepressants, the concept of clinical effectiveness has surfaced as a basic tenet of real-world practice. The concept of clinical effectiveness can lead to important insights into the treatment of depression and, by acting as an organizing concept for research, can help studies better focus on obtaining information necessary to improve clinical practice.
The limitations and strengths of efficacy and effectiveness studies in psychiatry are explored, and recent effectiveness studies in psychiatry are discussed, and their implications for re-examining treatment goals and remission.
Efficacy studies are invaluable for the development of new drugs, but often lack generalizability. In contrast, effectiveness studies are broader in scope and offer the potential to assess quality of life and functional change. Studies that explore the clinical effectiveness of treatments for depression can identify important treatment gaps and suggest ways to address them. Although the efficacy of an antidepressant is important, other factors such as patient adherence, safety and tolerability, and the alignment of treatment outcomes with dimensions likely to be critical to patients (quality of life and functioning) also need to be examined.
Antidepressant treatment, both in clinical practice and in research, should involve clinical considerations that go beyond efficacy data. Broader issues of tolerability, safety, residual symptoms, functioning, and quality of life must also be addressed. Accomplishing this objective may involve the development of new global effectiveness measures; better outcome measures; and a broader, more patient-centered orientation towards clinical care.
在一个关于抗抑郁药疗效的争论时代，临床效果的概念作为真实世界实践的基本原则已经出现。临床效果的概念可以为抑郁症的治疗提供重要的见解，并通过作为研究的组织概念，可以帮助研究更好地集中精力获得改善临床实践所需的信息。
探讨了精神病学中疗效和有效性研究的局限性和优势，并讨论了最近精神病学中的有效性研究，及其对重新检查治疗目标和缓解的影响。
疗效研究对于新药的开发非常有价值，但往往缺乏普遍性。相比之下，有效性研究范围更广，有可能评估生活质量和功能变化。探索抗抑郁治疗临床效果的研究可以发现重要的治疗差距，并提出解决这些差距的方法。虽然抗抑郁药的疗效很重要，但还需要考虑其他因素，如患者的依从性、安全性和耐受性，以及治疗结果与可能对患者至关重要的维度（生活质量和功能）的一致性。
抗抑郁治疗，无论是在临床实践还是在研究中，都应该考虑超出疗效数据的临床因素。还必须解决耐受性、安全性、残留症状、功能和生活质量等更广泛的问题。实现这一目标可能需要开发新的全球有效性衡量标准；更好的结果衡量标准；以及更广泛、更以患者为中心的临床护理方向。
