Monday, December 11, 2023

Antidepressants in patients with depression and comorbid medical conditions

One in three to six patients with medical illnesses receive antidepressants, but regulatory trials generally do not include comorbid medical illnesses.

Main points

What is the evidence for the use of antidepressants in the treatment or prevention of comorbid depression in patients with medical disorders?


This comprehensive systematic review identifies 176 individual systematic reviews of randomized clinical trials in 43 medical disorders and quantitatively summarizes and meta-analyses the results of 52 meta-analyses of antidepressant effects in 27 medical conditions. diseases; The results showed adequate quality in individual meta-analyses but a low quality in meta-analyzed clinical trials.

Compared to placebo, antidepressants show greater efficacy and worse tolerability and acceptability and are more likely to prevent depression.

Which means that antidepressants are effective and safe for treating and preventing depression in patients with medical illnesses, but there are very few large, high-quality trials.

she major depressive disorder (MDD) has a point prevalence of approximately 5% in the general population. Among people with medical disorders, MDD represents one of the most common comorbidities, with a prevalence point that often exceeds 10% or even 20%. In addition, many patients have subclinical symptoms of depression. Treatment of depression comorbid with medical illnesses is important because depression in these populations is associated with low quality of life and poor prognosis.

Antidepressants represent a first-line treatment, and the most recent meta-analysis of randomized clinical trials (RCTs) shows a small to medium effect size for certain antidepressants compared to placebo for of MDD in general. However, meta-analyses of antidepressant effectiveness are primarily based on RCTs that exclude people with medical conditions, which may limit generalizability. Given that one in three to six patients with a medical condition are treated with antidepressants, it is important to establish the effectiveness and safety of these patient populations.

Trials examining antidepressant treatment for depression comorbid with a medical illness tend to be more heterogeneous than important trials for regulatory purposes, ranging from small academic trials to larger consortia in a wide range of different medical diseases in different conditions. clinical or geographical. This situation results in a complex landscape of evidence for the treatment of comorbid depression that requires careful evaluation.

Currently, to our knowledge, there is no direct quantitative comparison of evidence between all individual pharmacological strategies in comorbid depression. In addition, the quality of included meta-analyses and RCTs was not assessed, which is an important step before treatment recommendations can be made with confidence.

To address this gap, we conducted a comprehensive systematic review of all available evidence on antidepressant use in depression comorbid with medical illnesses. We hypothesized that antidepressants are superior to placebo in the treatment of patients with depression and medical disorders and are reasonably acceptable, with potential differences between different medical disorders.

One in three to six patients with medical illnesses receive antidepressants, but regulatory trials generally do not include comorbid medical illnesses. Meta-analyses of antidepressants have shown small to medium effect sizes, but generalizability in clinical settings is unclear, where medical comorbidity is widespread.

To conduct a general systematic review of meta-analytic evidence and meta-analysis of the effectiveness and safety of antidepressant use in populations with medical disorders and comorbid depression.

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