Friday, April 10, 2020

Long-term outcome of depressive treatment

McPherson & Sunkin (2020) consider whether the independence of NICE (National Institute for Health and Care Excellence) may make it scientifically unaccountable, and use the debate about the depression guideline as an example. NICE is correct that there is limited available data on long-term follow-up, which, therefore, limits its usefulness for comparing treatment efficacy.

However, looking at outcome over the long-term does provide a different perspective from short-term trials, when even they leave room for interpretation about whether antidepressants are actually effective or not (see eg. previous post). Looking at how easy/difficult it is to treat depression in the long-term in an uncontrolled way shows that not everyone gets better and that recurrence is high (see previous post). Even so-called clinical improvement does not necessarily mean social recovery or complete elimination of symptoms. These sort of factors do need to be taken into account by NICE in any more comprehensive evaluation of the value of treatment in depression. Unless it does so, it may well leave itself open to judicial review.

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