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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Pharmacological interventions for people with depression and chronic physical health problems: systematic review and meta-analyses of safety and efficacy

Review published: 2011.

Bibliographic details: Taylor D, Meader N, Bird V, Pilling S, Creed F, Goldberg D.  Pharmacological interventions for people with depression and chronic physical health problems: systematic review and meta-analyses of safety and efficacy. British Journal of Psychiatry 2011; 198(3): 179-188. [PubMed: 21357876]

Quality assessment

The authors concluded that antidepressants were efficacious and safe in the treatment of depression occurring in the context of chronic physical health problems. The conclusions appear reliable, but inadequate handling of heterogeneity in some analyses suggest a need for caution. Full critical summary

Abstract

BACKGROUND: Antidepressant drugs are widely used in the treatment of depression in people with chronic physical health problems.

AIMS: To examine evidence related to efficacy, tolerability and safety of antidepressants for people with depression and with chronic physical health problems.

METHOD: Meta-analyses of randomised controlled efficacy trials of antidepressants in depression in chronic physical health conditions. Systematic review of safety studies.

RESULTS: Sixty-three studies met inclusion criteria (5794 participants). In placebo-controlled studies, antidepressants showed a significant advantage in respect to remission and/or response: selective serotonin reuptake inhibitors (SSRIs) risk ratio (RR) = 0.81 (95% CI 0.73-0.91) for remission, RR = 0.83 (95% CI 0.71-0.97) for response; tricyclics RR = 0.70 (95% CI 0.40-1.25 (not significant)) for remission, RR = 0.55 (95% 0.43-0.70) for response. Both groups of drugs were less well tolerated than placebo (leaving study early due to adverse effects) for SSRIs RR = 1.80 (95% CI 1.16-2.78), for tricyclics RR = 2.00 (95% CI 0.99-3.57). Only SSRIs were shown to improve quality of life. Direct comparisons of SSRIs and tricyclics revealed no advantage for either group for remission, response, effect size or tolerability. Effectiveness studies suggest a neutral or beneficial effect on mortality for antidepressants in participants with recent myocardial infarction.

CONCLUSIONS: Antidepressants are efficacious and safe in the treatment of depression occurring in the context of chronic physical health problems. The SSRIs are probably the antidepressants of first choice given their demonstrable effect on quality of life and their apparent safety in cardiovascular disease.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2012 University of York.

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