A network meta-analysis of 12,116 individuals from randomized controlled trials in the treatment of depression after acute coronary syndrome

Abstract

Background Post-acute coronary syndrome (ACS) depression is a common but not well understood complication experienced by ACS patients. Research on the effectiveness of various therapies remains limited. Hence, we sought to conduct a network meta-analysis to assess the efficacy of different interventions for post-ACS depression in improving patient outcomes. Methods and findings Three electronic databases were searched for randomised controlled trials describing different depression treatment modalities in post-ACS patients. Each article was screened based on inclusion criteria and relevant data were extracted. A bivariate analysis and a network meta-analysis was performed using risk ratios (RR) and standardized mean differences (SMD) for binary and continuous outcomes, respectively. A total of 30 articles were included in our analysis. Compared to standard care, psychosocial therapy was associated with the greatest reduction in depression scores (SMD:-1.21, 95% CI: -1.81 to -0.61, p<0.001), followed by cognitive behavioural therapy (CBT) (SMD: -0.75, 95% CI: -0.99 to -0.52, p<0.001), antidepressants (SMD: -0.73, 95% CI: -1.14 to -0.31, p<0.001), and lastly, combination therapy (SMD: -0.15, 95% CI: -0.28 to -0.03, p = 0.016). No treatment modalities was found to be more effective in reducing depression scores when compared to one another. Additional analysis showed that these treatment modalities did not have significant impact on the overall mortality, cardiac mortality and recurrent myocardial infarction. Conclusion This network meta-analysis found that the treatment effect of the various psychological modalities on depression severity were similar. Future trials on psychological interventions assessing clinical outcomes and improvement in adherence to ACS-specific interventions are needed.

Efficacy and Safety of Antidepressants in Patients With Comorbid Depression and Medical Diseases

“…Based on these descriptive data, we identified the largest systematic reviews within each medical disease. Data on primary and secondary outcome measures for these 73 systematic reviews are presented in eTable 7 in Supplement 2 for treatment of depression and in eTable 8 in Supplement 2 for prevention of depression.…”

Mental Health Is Heart Health: Adjusting Clinical Guidelines for Depression After Myocardial Infarction

“…A systematic review and meta-analysis of SSRIs shows that their use in post-acute coronary syndrome (ACS) patients with depression is associated with a statistically significant reduction in the risk of MI with no difference in mortality, hospitalization, angina, congestive heart failure, or stroke incidence 32 . An even more expansive meta-analysis spanning 12,116 participants and 30 studies shows associations between antidepressants, CBT, or combination therapy, and reduction in depression scores for post-MI patients 33 . From a pharmacologic perspective, sertraline, fluoxetine, and escitalopram are particularly promising SSRIs for use in the post-MI patient population 34–37 .…”

“…32 An even more expansive meta-analysis spanning 12,116 participants and 30 studies shows associations between antidepressants, CBT, or combination therapy, and reduction in depression scores for post-MI patients. 33 From a pharmacologic perspective, sertraline, fluoxetine, and escitalopram are particularly promising SSRIs for use in the post-MI patient population. [34][35][36][37] These meta-analyses and studies demonstrate that there are both safe and effective interventions for patients with post-MI depression.…”