Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis

Abstract

Depression can exacerbate symptoms associated with life-threatening illness and increase disability and distress. In palliative care, depression occurs in a context of multiple symptoms, which complicates detection and treatment. While systematic reviews of antidepressants have been conducted in specific life-threatening diseases, no previous study has synthesized the evidence in palliative care. The objective of this study was to determine the efficacy of antidepressants for the treatment of depression in palliative care. MEDLINE, EMBASE, PSYCINFO and Cochrane trials registers were systematically searched to identify randomized controlled trials comparing antidepressants and placebo for the treatment of depression in palliative care. The primary outcome was efficacy assessed at three time-points. Twenty-five studies were included in the review. At each time-point antidepressants were more efficacious than placebo: 4-5 weeks odds ratio (OR) 1.93 (1.15-3.42) p = 0.001; 6-8 weeks OR 2.25 (1.38-3.67) p = 0.001; 9-18 weeks OR 2.71 (1.50-4.91) p = 0.001. This review provides evidence that antidepressants are effective in treating depression in palliative care. Their superiority over placebo is apparent within 4-5 weeks and increases with continued use. It is probable that the effect sizes yielded in this review overestimate the efficacy of antidepressants due to biases such as selective reporting and publication. Nevertheless, the magnitude and consistency of the effect suggests genuine benefit.

Sick and Tired: Mood, Fatigue, and Inflammation in Cancer

“…More generally, efficacy of antidepressants in medically ill populations was evaluated in a Cochrane review, and results are encouraging, confirming superiority of antidepressant medication over placebo in the depressed medically ill [57]. This work was extended to palliative care populations; results again confirmed the benefit of antidepressant medications over placebo [58]. The bulk of the available high-quality evidence suggests that antidepressant medications are effective in medically ill depressed patients.…”

Depression in palliative care patients: a survey of assessment and treatment practices of Australian and New Zealand palliative care specialists

“…32 Further, a systematic review and meta-analysis of the use of antidepressants in palliative patients also supports antidepressant use for treating depression, but indicates there is insufficient evidence to recommend one medication over another. 33 The European Guidelines for the Management of Depression in Palliative Cancer Care suggest the use of a common antidepressant (sertraline, citalopram or mirtazapine) as the preferred pharmacological treatment, with TCAs as second-line agents if the patient has neuropathic pain. 29 The use of medications differs significantly between Australia and New Zealand, with New Zealand practitioners prescribing SSRIs, TCAs and psychostimulants more often.…”

Depression: Current treatments with low-cost strategies

“…Antidepressants induce serious side effects and this has been associated with non-adherence with medication (Usher et al 2013), poorer social function (Serretti and Mandelli 2010;Rayner et al 2011). Common side effects of antidepressants include, cardiac arrhythmias, constipation, insomnia, serotonin syndrome, movement disorders, serotonin discontinuation syndrome and sexual dysfunction (Kennedy and Rizvi 2009;Baldwin and Foong 2013).…”