Rayner, L., Price, A., Evans, A., Valsraj, K., Higginson, I.J., & Hotopf, M. (2010). Antidepressants for depression in physically ill people. Cochrane Database of Systematic Reviews, 3, CD007503.

To determine, by means of a meta-analysis and systematic review, the effectiveness of treatment with antidepressants in people with depression in the context of physical illness

• The Cochrane Register of Clinical Trials, MEDLINE,^® EMBASE, PsycINFO, ClinicalTrials.gov, Current Controlled Trials Register, LILACS, CINAHL,^® PSYNEX, AMED, and the pharmaceutical industry trials registers of GlaxoSmithKline and Eli Lilly were consulted.
• The following inclusion criteria were used: any type of antidepressant used; patients older than 18 years, with depression in the context of a physical illness; and depression defined as diagnosis of major depressive disorder, adjustment disorder, or dysthymic disorder, according to DMS-IV or ICD-10 or scores indicative of a diagnosis on validated tools. The main comorbidity was a physical health problem with a biological underpinning, not just symptoms. The control condition was a placebo.
• The study was excluded if patients had psychiatric comorbidity or if the study involved trials in which antidepressants were prescribed to treat symptoms other than those of depression.
   

• A total of 2,230 references were retrieved.
• Risk of bias was evaluated with Cochrane handbook criteria.
   

• 51 studies were included.
• Studies included patients with stroke, AIDS, Parkinson disease, cancer, chronic obstructive pulmonary disease, diabetes, myocardial infarction, renal failure, heart failure, epilepsy, and chronic prostatitis. Age range was 33–82.
• Four of the trials involved patients with cancer, mostly women with breast cancer. In those trials, the age range of the 254 patients was 35–91.
   

Most of the studies involved use of tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs); three studies looked at mirtazapine. In 25 studies providing data on short-term response, odds of response were greater with antidepressants (OR = 2.33, 95% CI, 1.8–3.0, p < 0.00001). Across 20 studies (N = 1,214 patients), at six to eight weeks antidepressants were more effective than placebo in reducing symptoms of depression (SMD = 0.66, 95% CI, –0.94 to –0.38, p < 0.00001). Analysis of medium-term response at 9–18 weeks showed odds of response were greater with antidepressant drugs than placebo (OR = 2.08, 95% CI, 1.33–3.24, p = 0.00001). Long-term response ( > 18 weeks) was better with antidepressants than placebo (OR = 2.13, 95% CI, 1.31–3.47, p = 0.002). Heterogeneity had a low impact on the meta-analysis reported. In the short term, fewer patients receiving placebo dropped out of the study. Most frequent adverse events were dizziness, dry mouth, headache, nausea, constipation, insomnia, sexual dysfunction, sedation, hypotension, and appetite change. No trials studied patients with advanced cancer,

Antidepressants were superior to placebo for treatment of depression in people with a physical illness.

The large number of studies were of relatively low quality, which may have inflated the effect sizes calculated. Depression was presumed to be similar across physical diseases. No subgroup analysis was conducted for different diseases.

Findings showed that treatment with antidepressants is superior to use of placebo in patients with physical illnesses who have moderate or major depressive disorders in the context of the physical illness. Antidepressants may benefit patients with cancer who have moderate to major depression. Applicability of antidepressants for patients with advanced cancer is unknown. Nurses should be aware of the side effects of antidepressants and how they may contribute to various disease or treatment symptoms.