A Critical Review - Management of depression and anxiety among adults in the UK Research Sample Paper

What is the effectiveness of antidepressants in the management of depression and anxiety among adults in the UK?



The essay aimed to examine the effectiveness of antidepressants in the management of depression and anxiety over CBT. A systematic review method was adopted focusing on the PubMed database. A total of 8 papers were obtained. Results showed that antidepressants are effective in reducing the symptoms of depression and anxiety. However, they should be used for a longer duration not just the 6 to 12 weeks noted in clinical trials. Antidepressants as part of medications are highly costly which would increase the costs of care. Thus, there is a need to include the use of psychotropics and CBT alongside antidepressants to achieve more effective results in managing depression and anxiety among adults in the UK.

Introduction and Research Question

This paper aims to examine the effectiveness of antidepressants in the management of depression and anxiety among adults in the United Kingdom. According to Penn and Tracy (2012), depression is a life-threatening disorder that affects millions of people across the world. Ormel, Kessler, and Schoevers (2019) add that depression is a huge burden to the individual and society, especially with increased costs of care.  Depression is also a major cause of disability within developed world countries such as the United Kingdom (Penn and Tracy, 2012). As a result, depressants have been used to manage depression. However, there is little understanding of their efficacy when compared to other treatments such as Cognitive Behavioural Therapy. Therefore, the rationale for this study is to conduct a review of the literature and provide evidence that would provide insights into the effectiveness of antidepressants over CBT and other interventions in the management of depression. The study would inform health professionals on measures they can take, whether to use antidepressants or CBT based on existing evidence that can assist in reducing depressive symptoms.

PICO and Research Question

Population: adults with depression and anxiety

Intervention: antidepressants

Comparison: CBT and other interventions

Outcome: reduced symptoms of depression and improved quality of life.

Research question: what is the effectiveness of antidepressants over CBT in the management of depression and anxiety among adults?


Search strategy (Method)

Search terms and inclusion/exclusion criteria

This essay adopts a systematic search process of searching for literature within the PubMed database. A systematic literature review is one of the research methods adopted to influence evidence-based practice. The evidence-based practice informs medical practitioners on the need to consider quality evidence when making decisions on how to provide the best care to patients while evaluating the quality of available evidence.  PubMed is one of the reputable databases with peer-reviewed articles in biomedical sciences. Thus, the database is used by scholars in the biomedical field to publish their papers. To conduct a literature search in the PubMed database, this study adopted search terms such as Effectiveness, antidepressants, CBT, depression, and anxiety.  However, there is a need to expand the search to include mode synonyms and exclude certain phrases. This is based on the assertions of Lindsey and Olin (2013) who noted that Boolean operators such as AND/OR/NOT should be used to combine the search terms and achieve a more focused search that can yield desired research studies. Thus, after applying the Boolean operators, the search phrase was narrowed down to ((effectiveness) AND (antidepressants)) AND (management of depression)

After the search has been conducted on the PubMed database, there was a need to consider inclusion and exclusion criteria. The inclusion criteria refer to all aspects that a research article has to possess for it to be included in the current study while the exclusion criteria contain all aspects of a research paper that are not relevant to the current study.

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Table 1: inclusion and exclusion criteria

Inclusion criteria


Exclusion criteria


Primary studies such as RCTs

Primary studies contain research design and methods adopted to collect evidence

Systematic reviews

They may contain studies that have already been included in this review thereby leading to biased analysis

Date of publication (last 10 years)

To use up-to-date evidence

Over the last 10 years

It may not be relevant to current practice

English language

The researcher can only read and understand the English language

Non-English language

Lack of ability and time to translate these studies into English


To focus on the research question

Children and adolescents

Does not focus on the research question and PICO framework

Figure 1: PRISMA flow diagram


Studies included in the review

(n = 8)




 Table of evidence







Nakagawa et al. (2017)

To examine the effectiveness of supplementing medication management as part of treatment as usual with CBT among patients with pharmacotherapy-resistant depression within a psychiatric specialty environment

A randomised controlled trial was adopted within 16 weeks as well as a further 12 months of follow-up.

A total of 80 patients were used. these were outpatients aged 20-65 years with pharmacotherapy-resistant depression, specifically those taking medications for more than 8 weeks. They randomised to CBT combined with TAU or TAU alone at a ratio of 1:1.

Results showed that supplementary CBT is effective in alleviating the symptoms of depression after 16 weeks of treatment based on mean changes in the GRID-Hamilton depression rating scale. These cores were greater within CBT and TAU Group than in the TAU group. Usual medication through the use of antidepressants should be supplemented with the use of CBT

This study does not provide insights into the experiences of patients, whether TAU or CBT can be effective in managing their depression.

Romijn et al. (2017)

To examine whether probiotics can be used to improve mood, and reduce stress and ad anxiety among patients with low mood.

The randomised controlled trial method was  adopted

A total of 79 participants not taking psychotropic medications with at least moderate scores on self-report mood measures were used. These patients were randomly allocated to probiotic preparation or a matched placebo. Blinded randomisation was conducted with the trial lasting 8 weeks

There is no evidence to support the need for the use of probiotic medication. Besides, there is no evidence that medication is effective in treating low mood or reducing the levels of inflammatory and other biomarkers. The lack of evidence may be attributed to side effects of medication leading to severity, chronicity, or resistance to treatment of low mood. Dry mouth and lack of sleep were part of the side effects in the control group

A sample of 79 patients with a further 10 dropping out may mean that the sample is not representative of the whole population

Wang et al. (2020)

To examine the effect of doses of S-ketamine on depression and pain management

A randomised controlled study design was adopted

Participants with cervical carcinoma were used, especially those with mild/moderate depression. A total of 417 cervical carcinoma patients were used. The patients were randomised into a control group, the racemic ketamine group, the high-dose s-ketamine group, and the low-dose s-ketamine group

A sub-anesthetic dose of 0.5 mg/kg and 0.25 mg/kg s-ketamine enhanced short-term depression and pain for cervical carcinoma patients after surgery and the effects were better than the same dose of racemic ketamine

It is not clear how the randomisation was done, or whether blinded to avoid bias.

Lewis et al. (2019)

The effectiveness of sertraline in reducing the symptoms of depression from mild to severe. They also tested the role of severity and duration in treatment response

A double-blind, placebo-controlled randomised trial was adopted

The focus was on 179 primary care patients from surgery within four UK cities such as Bristol, Liverpool, London, and York. Patients aged 18 to 74 years with depressive symptoms were used. The randomisation was in the ratio of 1:1 within sertraline or placebo

Sertraline is not likely to treat depression within 6 weeks in primary care. however, there were improvements in anxiety, quality of life, and self-rated mental health

There is a lack of longitudinal study for a long duration to examine the effectiveness of sertraline without focusing on 6 weeks only

Tarleton et al. (2017)

To test whether supplementation with over-the-counter magnesium chloride enhances the symptoms of depression

A randomized controlled trial was adopted through open-label blocked randomization. The intervention lasted 6 weeks

126 adults with a mean age of 52 years within outpatient primary care were used

Treatment with magnesium chloride for 6 weeks contributed to a clinically significant net improvement in patient health questionnaire-9 scores and improvements in generalised anxiety disorders. Overall, magnesium is effective for the mild or moderate treatment of depression among adults.

Open-label and block randomization may have led to the biased allocation of patients into the intervention and control group

Bradley et al. (2018)

To examine the effect of pharmacokinetics-guided treatment on patients with depression or anxiety

A randomized controlled design was adopted

685 patients from clinical providers focusing on psychiatry, internal medicine, obstetrics, Gynaecology, and family medicine were used

Pharmacokinetic-guided medication significantly improves outcomes for patients with depression or anxiety.

Highly quantitative with no focus on the views and experiences of patients

O'Hara et al. (2019)

To test the effectiveness of sertraline and interpersonal psychotherapy compared to the placebo pill

A randomised controlled design was adopted for 12 weeks

A total of 162 breastfeeding and non-breastfeeding women with depression episodes in the first year postpartum were used while focusing on Iowa and Rhode Island. They were randomly assigned to IPT, Sertraline, or Placebo pill

Results showed no significant effect for treatment conditions linked with the primary outcome measure. However, there was a significant effect for sertraline in reducing the symptoms of depression and anxiety

12 weeks of treatment is not sufficient to make the conclusions. More months and years of the trial should be considered.

Nakimuli-Mpungu et al. (2020)

To examine the effectiveness of psychotherapy in the management of depression

A randomised controlled study design was used

The focus was on people living with HIV in rural Uganda. A total of 1473 individuals with HIV were used

Psychological treatments such as psychotherapy prove to be effective in improving the mental health of people living with HIV

There is a lack of insights into the views and opinions of patients with HIV


A critical review of implications for practice

Implications for clinical practice, education, and research

Based on the evidence presented by Nakimuli-Mpungu et al. (2020), clinicians should consider the use of psychotherapy as a cost-effective method of improving the mental health of adults in the UK. This is based on the assumption that antidepressant medications can be costly.   In addition, antidepressants such as sertraline should be used to manage depression and anxiety as noted by O'Hara et al. (2019). However, Lewis et al. (2019) found that sertraline medication is not likely to be effective in reducing depressive symptoms within 6 weeks in primary care. Nevertheless, there were observed improvements in anxiety, quality of life, and self-rated mental health. The implication is that clinicians should focus on the use of sertraline for a longer duration, not just 6 weeks. They should also be aware of the side effects of the use of sertraline.  Clinicians can also focus on the use of pharmacokinetic-guided medication that was found to improve outcomes for patients diagnosed with depression or anxiety (Bradley et al. 2018). These medications can be extended and used among adults within the UK.

Tarleton et al. (2017) also presented evidence that magnesium is effective for the treatment of mild to moderate depression among adults. The implication is that magnesium can be explored by clinicians within the UK to treat depression and anxiety among adults. Moreover, Wang et al. (2020) revealed that a dose of S-ketamine had better effects on pain and depression than racemic ketamine among patients with cervical carcinoma with mild or moderate depression. Thus, clinicians should focus on the guise of S-ketamine to treat depression among adults in the UK.

Further research should be conducted while focussing on mixed-methods design whereby there is a consideration of the qualitative aspects, especially the views and experiences of patients treated with antidepressants and other medications to understand their views on the effectiveness of these medications in the management of depression and anxiety. The selected quantitative articles fail to consider the experiences of patients treated with antidepressants and whether they think that these medications should be used in the long term or their usage should be discontinued.

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Research quality of the included papers

The 8 papers that have been included in this essay have adopted a randomised controlled trial design. This is a high-quality experimental design that is adopted within clinical research.  However, there are concerns about the randomisation processes adopted. For instance, there is the use of double-blind randomisation as well as assessor-masked randomisation processes that focus on eliminating bias.  In the case of Wang et al. (2020), it is not clear how the randomisation was done, or whether blinded to avoid bias.


Bradley, P., Shiekh, M., Mehra, V., Vrbicky, K., Layle, S., Olson, M. C., & Lukowiak, A. A. (2018). Improved efficacy with targeted pharmacogenetic-guided treatment of patients with depression and anxiety: a randomized clinical trial demonstrating clinical utility. Journal of psychiatric research96, 100-107.

Lewis, G., Duffy, L., Ades, A., Amos, R., Araya, R., Brabyn, S., & Lewis, G. (2019). The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. The Lancet Psychiatry6(11), 903-914.

Lindsey, W. T., & Olin, B. R. (2013). PubMed searches: Overview and strategies for clinicians. Nutrition in Clinical Practice28(2), 165-176.

Nakagawa, A., Mitsuda, D., Sado, M., Abe, T., Fujisawa, D., Kikuchi, T., & Ono, Y. (2017). Effectiveness of supplementary cognitive-behavioral therapy for pharmacotherapy-resistant depression: a randomized controlled trial. The Journal of clinical psychiatry78(8), 2450.

Nakimuli-Mpungu, E., Musisi, S., Wamala, K., Okello, J., Ndyanabangi, S., Birungi, J., & Mills, E. J. (2020). Effectiveness and cost-effectiveness of group support psychotherapy delivered by trained lay health workers for depression treatment among people with HIV in Uganda: a cluster-randomised trial. The Lancet Global Health8(3), e387-e398.

O'Hara, M. W., Pearlstein, T., Stuart, S., Long, J. D., Mills, J. A., & Zlotnick, C. (2019). A placebo controlled treatment trial of sertraline and interpersonal psychotherapy for postpartum depression. Journal of affective disorders245, 524-532.

Ormel, J., Kessler, R. C., & Schoevers, R. (2019). Depression: More treatment but no drop in prevalence: how effective is treatment? And can we do better? Current opinion in psychiatry32(4), 348-354.

Penn, E., & Tracy, D. K. (2012). The drugs don’t work? Antidepressants and the current and future pharmacological management of depression. Therapeutic advances in psychopharmacology2(5), 179-188.

Romijn, A. R., Rucklidge, J. J., Kuijer, R. G., & Frampton, C. (2017). A double-blind, randomized, placebo-controlled trial of Lactobacillus helveticus and Bifidobacterium longum for the symptoms of depression. Australian & New Zealand Journal of Psychiatry51(8), 810-821.

Tarleton, E. K., Littenberg, B., MacLean, C. D., Kennedy, A. G., & Daley, C. (2017). Role of magnesium supplementation in the treatment of depression: A randomized clinical trial. PloS one12(6), e0180067.

Wang, J., Wang, Y., Xu, X., Peng, S., Xu, F., & Liu, P. (2020). Use of various doses of S-ketamine in treatment of depression and pain in cervical carcinoma patients with mild/moderate depression after laparoscopic total hysterectomy. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research26, e922028-1. 

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