Key result
Selective serotonin reuptake inhibitors significantly reduced the risk of not achieving remission compared to placebo in adults with depression and chronic physical health problems (RR 0.81).
Why the study?
Do antidepressants improve depression remission and response compared to placebo in patients with depression and chronic physical health problems?
Meta-Analysis (n=5,794)
Do antidepressants improve depression remission and response compared to placebo in patients with depression and chronic physical health problems?
Effect estimate: RR 0.81 (95% CI 0.73-0.91)
Antidepressants, particularly SSRIs, are efficacious for treating depression in patients with chronic physical illnesses, though they carry a higher risk of adverse effects leading to discontinuation compared to placebo.
Supports SSRI use in comorbid depression despite discontinuation risk; confirms efficacy from Level 1 meta-analysis.
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.
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Taylor et al. (2011) conducted a meta-analysis in Depression and chronic physical health problems (n=5,794). Selective serotonin reuptake inhibitors (SSRIs) vs. Placebo was evaluated on Not achieving remission of depression (RR 0.81, 95% CI 0.73-0.91). Selective serotonin reuptake inhibitors significantly reduced the risk of not achieving remission compared to placebo in adults with depression and chronic physical health problems (RR 0.81).
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