Mental health conditions remain common across all populations, including children and the elderly. Effective management of the disorders such as anxiety and depression involve both pharmacological and non-pharmacological approaches. Considering the pharmacological management, the introduction of new drugs presents controversy based on their effectiveness. For instance, Frenklach (2016) notes that a meta-analysis comparing placebo and Selective Serotonin Reuptake Inhibitors (SSRIs) had insufficient findings to reject the hypothesis that there was no variation in efficacy between these two pharmacological agents. It is therefore essential to evaluate the current evidence on SSRIs in reducing depressive and anxiety symptoms. This annotated bibliography entails six research articles that evaluate the effectiveness of SSRIs for patients with depression and anxiety.
Boland, J. R., Duffy, B., & Myer, N. M. (2018). Clinical utility of pharmacogenetics-guided treatment of depression and anxiety. Personalized Medicine in Psychiatry, 7, 7-13.
These authors aimed at establishing whether pharmacogenetics testing had an influence on the clinician decisions and prescription pattern. It further purposed to determine the putative genetic predictors of the management outcome. The sample involved 468 patients where the focus was on MTHFR and SLC6A4 genes and examining their possibility as predictors of MDD/GAD. The findings revealed that 50.6% of the clinicians made alterations to treatment which resulted to a 19.0% discontinuation rate of SSRI for individuals at risk of SLC6A4 and a 41.8% addition rate of folate derivative in MTHFR risk. This study recommended the importance of considering the genetic information of the patient in pharmacogenetic testing, which results in better clinical outcome. This study is of high evidence level as it presents primary findings on a wide range of aspects such as the importance of genetic information in influencing the clinician decision in using SSRIs.
Frenklach, A. (2016). Management of depression in Parkinson’s disease. American Journal of Psychiatry Residents’ Journal, 11(04), 8-11.
This case study aimed at examining the effectiveness of various mental health medication, including SSRIs for a patient with Parkinson disease. Further, this study purposed to familiarize with the validated treatment approaches for the condition. The case involved a 68-year-old male who had a 4-year history of Parkinson disease. His medication included citalopram. His condition improved after 2 weeks as reflected in reduced suicidal ideation and enhanced mood. This study further revealed that SSRIs are among the most common antidepressants for individuals with Parkinson disease. This treatment is preferred based on favorable side-effects. However, this article recommended further research on using these drugs since SSRIs are related to aggravated motor symptoms among patients with Parkinson disease. The quality of this study is high based on the case study and comprehensive literature on using SSRIs to manage depression.
Hu, M. X., Lamers, F., Penninx, B. W., & de Geus, E. J. (2018). Association between depression, anxiety, and antidepressant use with T-Wave amplitude and QT-interval. Frontiers in neuroscience, 12.
This study aimed at understanding the relationship between anxiety and depressive disorders and using antidepressants with QT-interval and T-wave amplitude. The sample size comprised 1383 individuals with depression and anxiety, where the use of SSRIs, SNRIs, and TCAs was established. The results showed that the SNRIs, SSRIs, and TCAs did not affect the corrected heart rate (QTc). This study provided the significance level and Cohen’s d for the different antidepressants to show their low evidence on a relationship with the QTc and TWA abnormalities. This study, therefore, recommended the use of these antidepressants, including SSRIs since there was no evidence linking them with TWA or QTc abnormalities. This study was primary and had a high level of evidence. The high quality of this study is based on the statistical data analysis, including the ANOVA. Besides, this study demonstrates that SSRIs and other antidepressants are not related to other abnormalities, which is critical in promoting their use.
Marchesi, C., Ossola, P., Amerio, A., Daniel, B. D., Tonna, M., & De Panfilis, C. (2016). Clinical management of perinatal anxiety disorders: A systematic review. Journal of Affective Disorders, 190, 543-550.
This systematic review aimed at understanding the clinical management of anxiety disorder among pregnant women. A total of 18 articles which met the inclusion criteria were used for the review. These studies supported using cognitive-behavioral therapy (CBT) for panic disorder, specific phobia, and obsessive-compulsive disorder (OCD). The findings revealed that SSRIs had a significant effect on PD and OCD improvement in both postpartum and pregnancy, and there were no side effects for the babies. In a recent clinical sample, it was established that 65% of the postpartum patients who had joined the open-label trial of 300 mg/day fluvoxamine demonstrated at least 30% reduction in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). This study recommended the use of SSRIs as first-line treatment approach for anxiety. This study was of moderate evidence and quality based on the systematic review methodology.
Puetz, T. W., Youngstedt, S. D., & Herring, M. P. (2015). Effects of pharmacotherapy on combat-related PTSD, anxiety, and depression: a systematic review and meta-regression analysis. PloS one, 10(5), e0126529.
This study compared the effects of different pharmacotherapy interventions for mental conditions including post-traumatic stress disorder (PTSD), depression, and anxiety. Another objective was to evaluate if the effects of these medications differed based on the intervention and patient. The sample involved 773 combat veterans that were diagnosed with PTSD and had received depression and anxiety interventions. The findings revealed that pharmacotherapy significantly lowered depressive, anxiety, and PTSD symptoms at a 95% confidence interval. Regarding the use of SSRIs, this study established that these medications had a greater outcome compared to others. The statistical significance was placed at 13.6 and 5.2 weeks for depression and anxiety, respectively. This study recommended the use of tricyclic and SSRIs antidepressants to address depressive symptoms for combat veterans. The study was a systematic review thus has a moderate level of evidence and quality.
Southammakosane, C., & Schmitz, K. (2015). Pediatric psychopharmacology for treatment of ADHD, depression, and anxiety. Pediatrics, 136(2), 351-359.
This review article aimed at empowering pediatricians in primary care through information on treatment modalities in mental health conditions such as anxiety, depression, and ADHD. Considering the use of SSRIs, this article provided a case study of a 13-year old who scored positive for severe depression. The initiation of an SSRI was based on referral for cognitive behavioral therapy. After four weeks of treatment, the patient demonstrates improvements where the depression becomes mild. Based on this case, the authors recommend particular dosing for SSRIs for patients with anxiety and depression. Both patients and healthcare providers should understand that the early effects of the SSRI treatment are seen at 1-2 weeks, although the efficacy of the medication is demonstrated after 4 weeks. This article involves a case study and clinician judgment, thus has a high level of evidence. It further provides comprehensive discussion regarding managing depression using different approaches including drugs and non-pharmacological interventions.