Are antidepressants effective in depression with a seasonal pattern/SAD? (Acute phase efficacy data)

Quality assessmentSummary of findingsImportance
No. of patientsEffectQuality
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsAcute phase treatment: antidepressantsControlRelative (95% CI)Absolute
Number not achieving =/> 50% reduction in SIGH-SAD score at endpoint (overall)
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone57/129 (44.2%)68/126 (54%)RR 0.82 (0.63 to 1.05)10 fewer per 100 (from 20 fewer to 3 more)⊕⊕⊕⊕
HIGH
57.8%10 fewer per 100 (from 21 fewer to 3 more)
Number not achieving =/> 50% reduction SIGH-SAD score
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious1none41/93 (44.1%)47/94 (50%)RR 0.88 (0.65 to 1.2)6 fewer per 100 (from 18 fewer to 10 more)⊕⊕○○
LOW
50%6 fewer per 100 (from 18 fewer to 10 more)
Number not achieving =/> 50% reduction in outcome score at endpoint - Fluoxetine vs Placebo
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious1none16/36 (44.4%)21/32 (65.6%)RR 0.68 (0.43 to 1.05)21 fewer per 100 (from 37 fewer to 3 more)⊕⊕○○
LOW
65.6%21 fewer per 100 (from 37 fewer to 3 more)
Mean endpoint SIGH-SAD (clinician rated) (antidepressants) (Better indicated by lower values)
2randomised trialsno serious limitationsserious2no serious indirectnessseriousnone5247-SMD 0.11 lower (0.65 lower to 0.42 higher)⊕⊕○○
LOW
Mean endpoint (clinician rated) (antidepressants) - Moclobemide vs Placebo (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious1none1615-SMD 0.23 higher (0.48 lower to 0.94 higher)⊕⊕○○
LOW
Mean endpoint (clinician rated) (antidepressants) - Fluoxetine vs Placebo (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious1none3632-SMD 0.33 lower (0.81 lower to 0.15 higher)⊕⊕○○
LOW
Mean endpoint BDI (self rated) - Fluoxetine vs Placebo (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious1none3632-MD 1.7 lower (6.53 lower to 3.13 higher)⊕⊕○○
LOW
Mean change (clinician rated) - Sertraline vs Placebo (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious3none9393-MD 4.51 lower (8.23 to 0.79 lower)⊕⊕⊕○
MODERATE
Relapse Prevention - Number of patients experiencing a recurrence
3randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone92/542 (17%)153/519 (29.5%)RR 0.58 (0.46 to 0.72)12 fewer per 100 (from 8 fewer to 16 fewer)⊕⊕⊕⊕
HIGH
31.9%13 fewer per 100 (from 9 fewer to 17 fewer)
1

Single study; inconclusive effect size

2

Significant heterogeneity - random effects model used

3

Single study

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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