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Tytuł:
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Antidepressant treatment outcomes in patients with and without comorbid physical or psychiatric disorders: A systematic review and meta-analysis.
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Autorzy:
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Kim HK; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Blumberger DM; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Fitzgerald PB; Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University Department of Psychiatry, Camberwell, Victoria, Australia.
Mulsant BH; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Daskalakis ZJ; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego School of Medicine, Biomedical Sciences Building, School of Medicine 9500 Gilman Drive, San Diego, California 92093-0603, United States. Electronic address: .
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Źródło:
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Journal of affective disorders [J Affect Disord] 2021 Dec 01; Vol. 295, pp. 225-234. Date of Electronic Publication: 2021 Aug 26.
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Typ publikacji:
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Journal Article; Meta-Analysis; Systematic Review
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Język:
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English
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Imprint Name(s):
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Original Publication: Amsterdam, Elsevier/North-Holland Biomedical Press.
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MeSH Terms:
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Depressive Disorder, Major*/drug therapy
Depressive Disorder, Major*/epidemiology
Antidepressive Agents/therapeutic use ; Bias ; Humans ; Treatment Outcome
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Contributed Indexing:
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Keywords: Antidepressants; Comorbidities; Major depressive disorder; Meta-analysis; Systematic review; Treatment outcome
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Substance Nomenclature:
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0 (Antidepressive Agents)
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Entry Date(s):
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Date Created: 20210904 Date Completed: 20211101 Latest Revision: 20211101
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Update Code:
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20240105
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DOI:
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10.1016/j.jad.2021.08.046
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PMID:
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34481151
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Background: Many patients with major depressive disorder (MDD) experience substantial impairment despite the availability of efficacious treatments. We performed a systematic review and meta-analysis to compare antidepressant outcomes in MDD with or without physical or psychiatric comorbidities.
Methods: Pubmed, EMBASE, and PsycInfo were searched up to May 14th, 2020 using keywords including MDD, antidepressant, medication, and comorbid. 1915 studies were reviewed. Studies that performed a direct and quantitative comparison of antidepressant effect in patients with MDD with or without comorbidities were included. Study characteristics and primary outcomes were extracted. Continuous and dichotomous variables were considered using standardized mean difference (SMD). Heterogeneity was measured using χ 2 and I 2 tests. Risk of bias was assessed using Cochrane Risk of Bias tool and NIH Quality Assessment Tool.
Results: 26 studies met selection criteria. Studies of physical (6 studies; I 2 = 57.69%, p = 0.04) and psychiatric comorbidities (20 studies; I 2 = 75.75%, p < 0.001) were heterogeneous. When compared to patients with MDD without comorbidities, those with physical (SMD = -0.19, 95% CI: -0.30 to -0.08, p = 0.001; 1910 and 2905 patients with or without comorbidities) or psychiatric comorbidities (SMD = -0.20, 95% CI: -0.31 to -0.095, p < 0.001; 4308 and 6867 patients with or without comorbidities) had worse antidepressant outcomes.
Limitations: Our limitations included aggregating the comorbidities into physical and psychiatric comorbidities and the high heterogeneity of the studies.
Conclusions: Our review provides updated evidence demonstrating that patients with MDD and physical or psychiatric comorbidities experience worse antidepressant outcomes.
(Copyright © 2021. Published by Elsevier B.V.)
