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Pharmacological interventions for people with depression and chronic physical health problems: systematic review and meta-analyses of safety and efficacy

  • David Taylor (a1), Nicholas Meader (a2), Victoria Bird (a2), Steve Pilling (a3), Francis Creed (a4) and David Goldberg (a5)...

Abstract

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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Copyright

Corresponding author

David Taylor, Pharmacy Department, Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK. Email: David.Taylor@slam.nhs.uk

Footnotes

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Declaration of interest

D.T. has received consultancies fees, lecturing honoraria and/or research funding from AstraZeneca, Janssen-Cilag, Servier, Sanofi-Aventis, Lundbeck, Bristol-Myers Squibb, Novartis, Eli Lilly and Wyeth. F.C. has received honoraria from Eli Lilly for speaking at scientific meetings.

Footnotes

References

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Pharmacological interventions for people with depression and chronic physical health problems: systematic review and meta-analyses of safety and efficacy

  • David Taylor (a1), Nicholas Meader (a2), Victoria Bird (a2), Steve Pilling (a3), Francis Creed (a4) and David Goldberg (a5)...

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Pharmacological interventions for people with depression and chronic physical health problems: systematic review and meta-analyses of safety and efficacy

  • David Taylor (a1), Nicholas Meader (a2), Victoria Bird (a2), Steve Pilling (a3), Francis Creed (a4) and David Goldberg (a5)...
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