Systematic Reviews: Clinical Scenario
In your out-patient clinic you see a 27 year old postgraduate student who describes long-standing depression, tiredness and lack of enjoyment. You diagnose dysthymia, but do not consider that there is a current superimposed depressive illness. You wonder about prescribing antidepressants. However, you are unsure which type of antidepressants are most effective in dysthymia or, indeed, whether there is evidence supporting their use in dysthymia at all. You formulate the clinical question 'in adults with dysthymia (problem), do antidepressants (intervention) improve mood (outcome) more than placebo (comparison intervention)?'
Fortunately, you have The Cochrane Library on your laptop in clinic. You enter the search term 'dysthymia'. In a second or two, it reveals that there are three completed systematic reviews of possible relevance, including one entitled 'drugs versus placebo for dysthymia'. Clicking on this title reveals the full text of the review, including a structured abstract.
Read the article and decide:
- Is the evidence from this systematic review valid?
- Is this valid evidence from this systematic review important?
- Can you apply this valid and important evidence from this systematic review in caring for your patient?