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Question: Are antidepressants effective, well tolerated and safe for people with depression and with chronic physical health problems?
Outcomes: Response, remission and tolerability, quality of life and physical health outcomes.
Design: Systematic review and meta-analysis.
Data sources: CENTRAL, CINAHL, EMBRASE, MEDLINE and PsycINFO.
Study selection and analysis: Randomised controlled trials (RCTs) involving the comparison of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), venlafaxine, duloxetine, mirtazapine, mianserin, trazodone (and other antidepressants licensed since 1958) with each other or with placebo in people with depression and a chronic physical illness. Chronic diseases were defined a priori and included asthma, cancer, cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, end-stage renal disease, epilepsy, general medical illness, HIV, multiple sclerosis (MS), Parkinson's disease, rheumatoid arthritis and stroke. Depression was defined as a DSM or ICD diagnosis or using a validated depression scale.
Sixty-three studies met inclusion criteria (n=5794); 35 comparing SSRIs with placebo. All but three of the studies were double blind. Seven of the studies looked at the treatment of depression in people with stroke; five in diabetes; four each in cardiovascular disease, cancer, Parkinson's disease and general medical illness; three in HIV; …
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