Pharmacopsychiatry 2007; 40(2): 77-81
DOI: 10.1055/s-2007-972574
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

A Randomized Controlled Clinical Trial Comparing “Guideline Exposed” and “Guideline Naive” Physicians in Respect to Dosage Selection and Treatment Outcome with Doxepin in Depressive Disorders

M. Linden 1 , K. Schotte 1
  • 1Research Group Psychosomatic Rehabilitation at the Charité, University Medical School, Berlin, Germany and the Rehabilitation Centre Seehof, Teltow/Berlin, Germany
Further Information

Publication History

received 10. 06. 06 revised 23. 12. 06

accepted 12. 01. 07

Publication Date:
19 April 2007 (online)

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Abstract

Introduction: Can prescribing of insufficient dosages and outcome of treatment with antidepressants in routine care be improved by guidelines?

Methods: 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.

Results: 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.

Conclusion: 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.

References

Correspondence

Prof. Dr. M. Linden

Research Group Psychosomatic Rehabilitation

Rehabilitation Centre Seehof

Lichterfelder Allee 55

14513 Teltow

Germany

Phone: +49/3328/34 56 78

Fax: +49/3328/34 55 55

Email: michael.linden@charite.de