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The current findings have direct implications for clinical guidelines concerning the use of antidepressants. One of the rationales for conducting this review was to verify certain claims made by the Royal College of Psychiatrists (RCP, 2004). Overall, the review yielded only partial support for these guidelines.

1. Firstly, the RCP states that people administered antidepressants show significant improvements over a placebo group. There was some evidence to support this view (e.g. Appleby et al, 1997; Simpson &Noble, 2000; Hendricks, 2003), although other publications reported no significant effects (e.g. Marcus et al, 2005). Overall, the beneficial effects of antidepressants are probable but not assured.

2. TCAs are considered to be just as effective as SSRIs albeit the latter drug is thought to be safer. The literature is evidence is not clear on this point. There are studies and literature reviews supporting the efficacy of both types of antidepressants (e.g. Goldstein & Sun dell, 1999; Cohen, 2005). However, a precise rather than subjective estimate of their relative effectiveness would requirement-analytic procedures, notably the computation of effect sizes. There is a paucity of meta-analytic evidence.

3. The RCP suggests that MAOIs can induce high blood pressure under certain (dietary) conditions. This review highlights a paucity of literature on the effects of MAOIs on infants (Cohen, 2005). Thus the side effects of these antidepressants in babies in not clear, so it may be safer for mothers to rely on TCAs or SSRIs during pregnancy/breastfeeding.

4. The RCP proposes that SNRIs are similar to SSRIs ineffectiveness. This review yielded insufficient evidence to warrant conclusive inferences on this claim.

5. The Royal College proposes that the babies of mothers who take antidepressants may experience withdrawal symptoms. Evidence suggests that any adverse effects on infants are generally benign (e.g. Nulmanet al, 1997, 2002). However, there is a lack of studies assessing long-term effects (Simpson & Noble, 2000; Hendricks, 2003). Moreover there is evidence of sustained neurobehavioral outcomes in infants(Oberlander et al, 2005).

6. The RCP asserts that it is best to carry on taking antidepressants during breastfeeding, because only minute amounts will be transferred to the baby. There is evidence confirming that antidepressants, both TCAs and SSRIs, are found in very small amounts in the serum of breast-fed infants (Cohen, 2005). However caution is advised since overall the evidence base concerning breast-feeding is inconclusive (Simpson & Noble, 2000; Misery & Kostas’s, 2002;Hendrick, 2003).

Overall, the general theme emerging from the present review is caution. The paucity of randomised controlled trials, which allow causal inferences, and methodological and analytical limitations of the available literature means that antidepressants must be prescribed guardedly, and probably only as a last resort (after other interventions [e.g. cognitive behavioural therapy] have been considered) and/or when patients present with severe rather than mild depressive symptoms. An本论文由英语论文网提供整理，提供论文代写，英语论文代写，代写论文，代写英语论文，代写留学生论文，代写英文论文，留学生论文代写相关核心关键词搜索。