Is duloxetine effective as a continuation treatment following a 30% improvement in baseline (HAMD-17) symptoms of depression?

Quality assessmentSummary of findingsImportance
No. of patientsEffectQuality
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsContinuation phase for those with 30% improvement in baseline HAMD- 17 scores: duloxetinePlaceboRelative (95% CI)Absolute
Mean change scores from end of acute phase - 80 mg (measured with: HAMD; Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyserious1serious1none7070-MD 1 lower (2.5 lower to 0.5 higher)⊕⊕○○
LOW
Mean change scores from end of acute phase - 120 mg (measured with: HAMD; Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyserious2serious1none8070-MD 0.2 lower (1.78 lower to 1.38 higher)⊕⊕○○
LOW
Leaving treatment early - for any reason - 80 mg
1randomised trialsno serious limitationsno serious inconsistencyserious2serious1none58/71 (81.7%)62/71 (87.3%)RR 0.94 (0.81 to 1.08)5 fewer per 100 (from 17 fewer to 7 more)⊕⊕○○
LOW
Leaving treatment early - for any reason - 120 mg
1randomised trialsno serious limitationsno serious inconsistencyserious2serious1none62/81 (76.5%)62/71 (87.3%)RR 0.88 (0.75 to 1.02)10 fewer per 100 (from 22 fewer to 2 more)⊕⊕○○
LOW
Leaving treatment early - adverse reactions - 80 mg
2randomised trialsno serious limitationsno serious inconsistencyserious2no serious imprecisionnone7/146 (4.8%)6/129 (4.7%)RR 0.96 (0.34 to 2.73)0 fewer per 100 (from 3 fewer to 8 more)⊕⊕⊕○
MODERATE
Leaving treatment early - adverse reactions - 120 mg
2randomised trialsno serious limitationsno serious inconsistencyserious2no serious imprecisionnone6/151 (4%)6/129 (4.7%)RR 0.84 (0.28 to 2.54)1 fewer per 100 (from 3 fewer to 7 more)⊕⊕⊕○
MODERATE
Leaving treatment early - lack of efficacy - 80 mg
1randomised trialsno serious limitationsno serious inconsistencyserious2serious1none1/71 (1.4%)1/71 (1.4%)RR 1 (0.06 to 15.68)0 fewer per 100 (from 1 fewer to 21 more)⊕⊕○○
LOW
Leaving treatment early - lack of efficacy - 120 mg
1randomised trialsno serious limitationsno serious inconsistencyserious2serious1none4/81 (4.9%)1/71 (1.4%)RR 3.51 (0.4 to 30.65)4 more per 100 (from 1 fewer to 42 more)⊕⊕○○
LOW
1

Single study

2

Selective patients from multiple sites

From: APPENDIX 16, CLINICAL EVIDENCE PROFILES

Cover of Depression
Depression: The Treatment and Management of Depression in Adults (Updated Edition).
NICE Clinical Guidelines, No. 90.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2010.
Copyright © The British Psychological Society & The Royal College of Psychiatrists, 2010.

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