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.doi: 10.1002/14651858.CD007503.pub2
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
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.