TY - JOUR
T1 - Pharmacological management of depression
T2 - Japanese expert consensus
AU - Medical Education Panel of the Japanese Society of Clinical Neuropsychopharmacology
AU - Sakurai, Hitoshi
AU - Uchida, Hiroyuki
AU - Kato, Masaki
AU - Suzuki, Takefumi
AU - Baba, Hajime
AU - Watanabe, Koichiro
AU - Inada, Ken
AU - Kikuchi, Toshiaki
AU - Katsuki, Asuka
AU - Kishida, Ikuko
AU - Sugawara Kikuchi, Yuka
AU - Yasui-Furukori, Norio
N1 - Funding Information:
Japan, and Yoshitomi Yakuhin, and research grants from Eisai, Mochida Pharmaceutical, and Meiji Seika Pharma. Dr. Baba reports grants from Novartis, personal fees from MSD, personal fees from Otsuka, personal fees from Dainippon Sumitomo, personal fees from Meiji Seika, personal fees from Eli Lilly, personal fees from Yoshitomi, personal fees from Janssen, personal fees from Kyowa, personal fees from Mitsubishi Tanabe, personal fees from Ono, personal fees from Pfizer, personal fees from Takeda, outside the submitted work. Dr. Watanabe has received manuscript fees or speaker's honoraria from Daiichi Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutical, Kyowa Pharmaceutical, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Pfizer, Shionogi, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, Yoshitomi, and has received research/grant support from Astellas Pharma , Japan, Daiichi Sankyo, Eisai , MSD , Japan, Mitsubishi Tanabe Pharma, Meiji Seika Pharma , Otsuka Pharmaceutical , Pfizer , Shionogi , Sumitomo Dainippon Pharma, and is a consultant of Eisai, Eli Lilly, Kyowa Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Sumitomo Dainippon Pharma, Taisho Toyama Pharmaceutical, and Takeda Pharmaceutical. Dr. Inada reports personal fees from Dainippon Sumitomo Pharma, personal fees from Eisai, personal fees from Eli Lilly Japan, personal fees from Janssen pharmaceutical, personal fees from Meiji-Seika Pharmaceutical, personal fees from Mochida, grants and personal fees from MSD, personal fees from Novartis, personal fees from Otsuka Pharmaceutical, personal fees from Shionogi, personal fees from Tanabe-Mitsubishi Pharma, personal fees from Yoshitomi Yakuhin, outside the submitted work. Dr. Toshiaki Kikuchi reports personal fees from Otsuka Pharmaceutical, personal fees from Dainippon-Sumitomo, personal fees from Eli Lilly, personal fees from Mochida, personal fees from Meiji-Seika, personal fees from Yoshitomi-Yakuhin, personal fees from Takeda, personal fees from MSD, personal fees from Pfizer, outside the submitted work. Dr. Katsuki reports personal fees from Dainippon Sumitomo Pharma. Dr. Kishida and Dr. Yuka Sugawara Kikuchi have nothing to disclose. Dr. Norio Yasui-Furukori has been a speaker for Dainippon-Sumitomo Pharmaceutical, Mochida Pharmaceutical, Otsuka Pharmaceutical and MSD for other studies within the past three years. The funders had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.
Funding Information:
This work was supported by the GlaxoSmith Kline medical education project grant. The authors thank Asaki Matsuzaki for his support in the previous presentation.
Funding Information:
Japan, and Yoshitomi Yakuhin, and research grants from Eisai, Mochida Pharmaceutical, and Meiji Seika Pharma. Dr. Baba reports grants from Novartis, personal fees from MSD, personal fees from Otsuka, personal fees from Dainippon Sumitomo, personal fees from Meiji Seika, personal fees from Eli Lilly, personal fees from Yoshitomi, personal fees from Janssen, personal fees from Kyowa, personal fees from Mitsubishi Tanabe, personal fees from Ono, personal fees from Pfizer, personal fees from Takeda, outside the submitted work. Dr. Watanabe has received manuscript fees or speaker's honoraria from Daiichi Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutical, Kyowa Pharmaceutical, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Pfizer, Shionogi, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, Yoshitomi, and has received research/grant support from Astellas Pharma, Japan, Daiichi Sankyo, Eisai, MSD, Japan, Mitsubishi Tanabe Pharma, Meiji Seika Pharma, Otsuka Pharmaceutical, Pfizer, Shionogi, Sumitomo Dainippon Pharma, and is a consultant of Eisai, Eli Lilly, Kyowa Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Sumitomo Dainippon Pharma, Taisho Toyama Pharmaceutical, and Takeda Pharmaceutical. Dr. Inada reports personal fees from Dainippon Sumitomo Pharma, personal fees from Eisai, personal fees from Eli Lilly Japan, personal fees from Janssen pharmaceutical, personal fees from Meiji-Seika Pharmaceutical, personal fees from Mochida, grants and personal fees from MSD, personal fees from Novartis, personal fees from Otsuka Pharmaceutical, personal fees from Shionogi, personal fees from Tanabe-Mitsubishi Pharma, personal fees from Yoshitomi Yakuhin, outside the submitted work. Dr. Toshiaki Kikuchi reports personal fees from Otsuka Pharmaceutical, personal fees from Dainippon-Sumitomo, personal fees from Eli Lilly, personal fees from Mochida, personal fees from Meiji-Seika, personal fees from Yoshitomi-Yakuhin, personal fees from Takeda, personal fees from MSD, personal fees from Pfizer, outside the submitted work. Dr. Katsuki reports personal fees from Dainippon Sumitomo Pharma. Dr. Kishida and Dr. Yuka Sugawara Kikuchi have nothing to disclose. Dr. Norio Yasui-Furukori has been a speaker for Dainippon-Sumitomo Pharmaceutical, Mochida Pharmaceutical, Otsuka Pharmaceutical and MSD for other studies within the past three years. The funders had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.
Publisher Copyright:
© 2020
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Clinically relevant issues in the real-world treatment of depression have not always been captured by conventional treatment guidelines. Methods: Certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology were asked to evaluate treatment options regarding 23 clinical situations in the treatment of depression using a 9-point Likert scale (1=“disagree” and 9=“agree”). According to the responses of 114 experts, the options were categorized into first-, second-, and third-line treatments. Results: First-line antidepressants varied depending on predominant symptoms: escitalopram (mean ± standard deviation score, 7.8 ± 1.7) and sertraline (7.3 ± 1.7) were likely selected for anxiety; duloxetine (7.6 ± 1.9) and venlafaxine (7.2 ± 2.1) for loss of interest; mirtazapine for insomnia (8.2 ± 1.6), loss of appetite (7.9 ± 1.9), agitation and severe irritation (7.4 ± 2.0), and suicidal ideation (7.5 ± 1.9). While first-line treatment was switched to either an SNRI (7.7 ± 1.9) or mirtazapine (7.4 ± 2.0) in the case of non-response to an SSRI, switching to mirtazapine (7.1 ± 2.2) was recommended in the case of non-response to an SNRI, and vice versa (switching to an SNRI (7.0 ± 2.0) in the case of non-response to mirtazapine). Augmentation with aripiprazole was considered the first-line treatment for partial response to an SSRI (7.1 ± 2.3) or SNRI (7.0 ± 2.5). Limitations: The evidence level of expert consensus is considered low. All included experts were Japanese. Conclusions: Recommendations made by experts in the field are useful and can supplement guidelines and informed decision making in real-world clinical practice. We suggest that pharmacological strategies for depression be flexible and that each patient's situational needs as well as the pharmacotherapeutic profile of medications be considered.
AB - Background: Clinically relevant issues in the real-world treatment of depression have not always been captured by conventional treatment guidelines. Methods: Certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology were asked to evaluate treatment options regarding 23 clinical situations in the treatment of depression using a 9-point Likert scale (1=“disagree” and 9=“agree”). According to the responses of 114 experts, the options were categorized into first-, second-, and third-line treatments. Results: First-line antidepressants varied depending on predominant symptoms: escitalopram (mean ± standard deviation score, 7.8 ± 1.7) and sertraline (7.3 ± 1.7) were likely selected for anxiety; duloxetine (7.6 ± 1.9) and venlafaxine (7.2 ± 2.1) for loss of interest; mirtazapine for insomnia (8.2 ± 1.6), loss of appetite (7.9 ± 1.9), agitation and severe irritation (7.4 ± 2.0), and suicidal ideation (7.5 ± 1.9). While first-line treatment was switched to either an SNRI (7.7 ± 1.9) or mirtazapine (7.4 ± 2.0) in the case of non-response to an SSRI, switching to mirtazapine (7.1 ± 2.2) was recommended in the case of non-response to an SNRI, and vice versa (switching to an SNRI (7.0 ± 2.0) in the case of non-response to mirtazapine). Augmentation with aripiprazole was considered the first-line treatment for partial response to an SSRI (7.1 ± 2.3) or SNRI (7.0 ± 2.5). Limitations: The evidence level of expert consensus is considered low. All included experts were Japanese. Conclusions: Recommendations made by experts in the field are useful and can supplement guidelines and informed decision making in real-world clinical practice. We suggest that pharmacological strategies for depression be flexible and that each patient's situational needs as well as the pharmacotherapeutic profile of medications be considered.
KW - Antidepressant
KW - Depression
KW - Expert consensus guideline
KW - Treatment guideline
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U2 - 10.1016/j.jad.2020.01.149
DO - 10.1016/j.jad.2020.01.149
M3 - Article
C2 - 32056937
AN - SCOPUS:85079166127
VL - 266
SP - 626
EP - 632
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
SN - 0165-0327
ER -