Tuesday 29 June 2010, 10:44AM
PEARLS 257, May 2010, written by Brian R McAvoy
Clinical question
How effective are antidepressants for depression in patients with a
physical illness?
Bottom line
Antidepressants were more effective than placebo in treating
depression in physically ill patients. The superiority of
antidepressants over placebo was apparent within 4-5 weeks (NNT* 6)
and persisted after 18 weeks (NNT 7). Subgroup analysis showed both
tricyclic antidepressants (TCAs) and selective serotonin reuptake
inhibitors (SSRIs) were superior to placebo in treating depression
in physically ill patients. Antidepressants were associated with
increased rates of dry mouth (particularly TCAs) and sexual
dysfunction (particularly SSRIs) compared with placebo. There was
no evidence of a difference in drop-out between TCAs and SSRIs.
Subgroup analysis suggested TCAs, which are often considered
inappropriate for physically ill patients,¹ are as effective and as
acceptable to patients as SSRIs. There are no grounds to recommend
a specific antidepressant on the basis of this review, which
included studies evaluating a total of 22 different drugs. * NNT =
number needed to treat to benefit 1 individual
Caveat
At 6-8 weeks, there were more drop-outs among patients treated with
an antidepressant than among patients treated with placebo
(NNH**19), but no difference was observed at the other time-points
assessed. Due to potential biases, such as selective publication,
small sample sizes and the variable methodological quality of
trials, it is likely the effect sizes obtained in this review
overestimate the efficacy of antidepressants. ** NNH = number
needed to treat to cause harm in 1 individual
Context
Antidepressants are effective in the treatment of depression in
physically healthy populations, but there is less clarity regarding
their use in physically ill patients.
Cochrane Systematic Review
Rayner L et al. Antidepressants for depression in physically ill
people. Cochrane Reviews 2010, Issue 3. Article No. CD0057503. DOI:
10.1002/14651858.CD007503.pub2. This review contains 51 studies
involving 3603 participants.
Further references
1. Taylor D. Acta Psychiatr Scand 2008;118:434Ð42.