SSRIs are a family of antidepressants that work as well or as poorly as other groups. Recent systematic reviews have questioned the effectiveness of antidepressants over placebo. It seems that its effects are not very different from placebo in mild or moderate depression and there is evidence of some effectiveness in severe depression.
But clinical trials are one thing and real practice is another. There is great inter-individual variability in response to antidepressants and this is difficult to predict. It is difficult to predict whether and to what degree our patient will respond to the antidepressant. Therefore, as important (or more) than the selection and correct indication of a specific antidepressant for a specific patient is to carefully monitor the effectiveness obtained (in relation to the planned goals) and then adjust or modify the therapeutic strategy according to the observed response.
Maslej MM, Furukawa TA, Cipriani A, et al. Individual Differences in Response to Antidepressants: A Meta-analysis of Placebo-Controlled Randomized Clinical Trials. JAMA Psychiatry. 2021;78(5):490–497. doi:10.1001/jamapsychiatry.2020.4564
Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018 Apr 7;391(10128):1357-1366. doi: 10.1016/S0140-6736(17)32802-7.
Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008 Feb;5(2):e45. doi: 10.1371/journal.pmed.0050045.
Both therapeutic effects and side-effects are dose dependent. Hence the limited recommended dose range of 10-20mg daily for adults treated with escitalopram. Less might not help. More might cause upset stomach.
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Logicaly, it does matter, cover everything in moderate and resistant depressions. But, we must not forget about the help of psychotherapy, which enhance´s its action and effect!!!
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