Is augmenting existing antidepressant treatment with another psychotropic drug effective for depression that has not adequately responded to treatment?

Quality assessmentSummary of findingsImportance
No. of patientsEffectQuality
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsAugmentation: AD + other psychotropic drugAD + (placebo or nothing)Relative (95% CI)Absolute
Number not achieving response - Antidpressants + lithium
6randomised trialno serious limitationsserious1no serious indirectnessno serious imprecision2none56/87 (64.4%)68/86 (79.1%)RR 0.83 (0.66 to 1.03)13 fewer per 100 (from 27 fewer to 2 more)⊕⊕⊕○
MODERATE
81.8%13 fewer per 100
Number not achieving remission - Antidepressants + lithium
3randomised trialno serious limitationsserious2no serious indirectnessserious3none57/107 (53.3%)53/109 (48.6%)RR 1.26 (0.72 to 2.17)13 more per 100 (from 14 fewer to 57 more)⊕⊕○○
LOW
53.3%13 more per 100
Number not achieving remission - Antidepressants + atomoxetine
1randomised trialno serious limitationsno serious inconsistencyno serious indirectnessvery serious4none43/72 (59.7%)36/74 (48.6%)RR 1.23 (0.91 to 1.66)11 more per 100 (from −4 fewer to 32 more)⊕⊕○○
LOW
48.7%11 more per 100
Mean endpoint or change scores - Antidepressants + lithium (range of scores: Better indicated by less)
7randomised trialno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone135138-SMD − 0.32 (− 0.56 to − 0.08)⊕⊕⊕⊕
HIGH
Mean endpoint or change scores - Antidepressants + atomoxetine (range of scores: Better indicated by less)
1randomised trialno serious limitationsno serious inconsistencyno serious indirectnessvery serious4none7071-SMD − 0.23 (− 0.56 to 0.1)⊕⊕○○
LOW
Leaving the study early - Antidepressants + lithium
8randomised trialno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionnone55/178 (30.9%)31/178 (17.4%)RR 1.79 (1.23 to 2.6)14 more per 100 (from 4 more to 28 more)⊕⊕⊕⊕
HIGH
9.8%7 more per 100
Leaving the study early - Antidepressants + atomoxetine
1randomised trialno serious limitationsno serious inconsistencyno serious indirectnessvery serious4none13/72 (18.1%)13/74 (17.6%)RR 1.03 (0.51 to 2.06)1 more per 100 (from −9 fewer to 19 more)⊕⊕○○
LOW
17.6%0 more per 100
Leaving the study early due to side effects - Antidepressants + atomoxetine
1randomised trialno serious limitationsno serious inconsistencyno serious indirectnessvery serious4none7/72 (9.7%)4/74 (5.4%)RR 1.8 (0.55 to 5.88)4 more per 100 (from −2 fewer to 26 more)⊕⊕○○
LOW
5.4%4 more per 100
1

Significant heterogeneity - random effects model used

2

Not needed

3

Inconclusive effect size

4

Single study; inconclusive effect size

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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