Dose effects of tricyclic antidepressants in the treatment of acute depression – A systematic review and meta-analysis of randomized trials

Baethge, Christopher; Braun, Cora; Rink, Lena; Schwarzer, Guido; Henssler, Jonathan; Bschor, Tom

doi:10.1016/j.jad.2022.03.075

Cited by 7 publications

(6 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…13,16,77,78 For example, in a meta-analysis of antidepressant drug treatment at various time points between 8 and 24 weeks, effects remained within a range of 0.24 to 0.34. 14 Given the moderate effect size and absent clean-cut criteria of what constitutes a clinically meaningful improvement in quality of life, we argue that the case for a convincing effect is still out. That does not preclude important improvements in individual cases.…”

Section: Discussionmentioning

confidence: 92%

“…Two authors (TW, SK) independently extracted data from the studies included using a standardized Excel‐form similar to those employed in earlier studies of our group 12 – 16 . Specifically, we collected information on number, gender, and age of participants, diagnosis, interventions, trial duration, psychometric instruments employed, results (point estimates and measures of dispersion), as well as meta‐data regarding authors, journal, publication year, and funding source.…”

Section: Data Collectionmentioning

confidence: 99%

See 1 more Smart Citation

Antidepressants and quality of life in patients with major depressive disorder – Systematic review and meta‐analysis of double‐blind, placebo‐controlled RCTs

Wiesinger

Kremer

Bschor

et al. 2023

Acta Psychiatr Scand

Self Cite

View full text Add to dashboard Cite

Background: Quality of Life (QoL) is an important outcome in mental disorders. We investigated whether antidepressant pharmacotherapy improved QoL vs. placebo among patients with MDD.Methods: Systematic literature search in CENTRAL, Medline, PubMed Central, and PsycINFO of double-blind, placebo-controlled RCTs. Screening, inclusion, extraction, and risk of bias assessment were conducted independently by two reviewers. We calculated summary standardized mean differences (SMD) with 95%-CIs. We followed Cochrane Collaboration's Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF).Results: We selected 46 RCTs out of 1807 titles and abstracts screened, including 16.171 patients, 9131 on antidepressants and 7040 on placebo, a mean age of 50.9 years, with 64.8% women. Antidepressant drug treatment resulted in a SMD in QoL of 0.22 ([95%-CI: 0.18; 0.26] I 2 39%) vs. placebo. SMDs differed by indication: 0.38 ([0.29; 0.46] I 2 0%) in maintenance studies, 0.21 ([0.17; 0.25] I 2 11%) in acute treatment studies, and 0.11 ([À0.05; 0.26], I 2 51%) in studies focussing on patients with a physical condition and major depression. There was no indication of subtstantial small study effects, but 36 RCTs had a high or uncertain risk of bias, particularly maintenance trials. QoL and antidepressive effect sizes were associated (Spearman's rho 0.73, p < 0.001).Conclusions: Antidepressants' effects on QoL are small in primary MDD, and doubtful in secondary major depression and maintenance trials. The strong correlation of QoL and antidepressive effects indicates that the current practice of measuring QoL may not provide sufficient additional insights into the wellbeing of patients.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Data Collectionmentioning

confidence: 99%

Antidepressants and quality of life in patients with major depressive disorder – Systematic review and meta‐analysis of double‐blind, placebo‐controlled RCTs

Wiesinger

Kremer

Bschor

et al. 2023

Acta Psychiatr Scand

Self Cite

View full text Add to dashboard Cite

show abstract

“…Independently, two authors (S.K., T.W.) extracted data on the studies included employing a pre-specified and standardized Excel form resembling those used in previous studies of our group Antidepressant Treatment and Social Functioning [8, [15][16][17][18][19]. By study, we documented information on number, sex, and age of subjects, diagnosis, interventions, trial duration, psychometric instruments employed, results (point estimates and measures of dispersion), and meta-data regarding authors, journal, and publication year.…”

Section: Data Collectionmentioning

confidence: 99%

Antidepressants and Social Functioning in Patients with Major Depressive Disorder: Systematic Review and Meta-Analysis of Double-Blind, Placebo-Controlled RCTs

Kremer,

Wiesinger,

Bschor

et al. 2023

Psychother Psychosom

Self Cite

View full text Add to dashboard Cite

Introduction: Social functioning (SF) is the ability to fulfil one’s social obligations and a key outcome in treatment. Objective: The aim of the study was to estimate the effects of antidepressants on SF in patients with major depressive disorder (MDD). Methods: This meta-analysis and its reporting are based on Cochrane Collaboration’s Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF). We systematically searched CENTRAL, Medline, PubMed Central, and PsycINFO for double-blind RCTs comparing antidepressants with placebo and reporting on SF. We computed standardized mean differences (SMDs) with 95% CIs and prediction intervals. Results: We selected 40 RCTs out of 1,188 records screened, including 16,586 patients (mean age 46.8 years, 64.2% women). In 27 studies investigating patients with MDD (primary depression), antidepressants resulted in a SMD of 0.25 compared to placebo ([95% CI: 0.21; 0.30] I2: 39%). In 13 trials with patients suffering from MDD comorbid with physical conditions or disorders, the summary estimate was 0.24 ([0.10; 0.37] I2: 75%). In comorbid depression, studies with high/uncertain risk of bias had higher SMDs than low-risk studies: 0.29 [0.13; 0.44] versus 0.04 [−0.16; 0.24]; no such effect was evident in primary depression. There was no indication of sizeable reporting bias. SF efficacy correlated with efficacy on depression scores, Spearman’s rho 0.67 (p < 0.001), and QoL, 0.63 (p < 0.001). Conclusions: The effect of antidepressants on SF is small, similar to its effect on depressive symptoms in primary MDD, and doubtful in comorbid depression. Strong correlations with both antidepressive and QoL effects suggest overlap among domains.

show abstract

“…Die aktuelle systematische Metaanalyse zur Dosiswirkungsbeziehung von TZA konnte 15 randomisierte Studien mit insgesamt knapp 1000 Patienten einschließen. Es fand sich ein stärkerer antidepressiver Effekt für eine um 100 mg/d höher liegende Dosierung, der aber nicht statistisch signifikant war 15 . Die Nationale VersorgungsLeitlinie Depression 16 empfiehlt daher in ihrer aktuellen Auflage „Bei Patienten, die mit Serumspiegeln im therapeutischen Bereich nicht auf eine Monotherapie mit einem SSRI ansprechen, soll die Dosis des SSRI nicht erhöht werden.“ sowie „Bei Patienten, die mit Serumspiegeln im therapeutischen Bereich nicht auf eine Monotherapie mit MAO-Inhibitoren, SNRI oder TZA ansprechen, sollte die Dosis nicht erhöht werden.“.…”

Section: Dosissteigerung Ist Keine Empfehlenswerte Strategie Bei Unzu...unclassified

Walter H, Haaf R, Köhler S. Therapiemöglichkeiten der Depression nach Non-Response

2023

Nervenheilkunde

View full text Add to dashboard Cite

Dose effects of tricyclic antidepressants in the treatment of acute depression – A systematic review and meta-analysis of randomized trials

Cited by 7 publications

References 28 publications

Antidepressants and quality of life in patients with major depressive disorder – Systematic review and meta‐analysis of double‐blind, placebo‐controlled RCTs

Antidepressants and quality of life in patients with major depressive disorder – Systematic review and meta‐analysis of double‐blind, placebo‐controlled RCTs

Antidepressants and Social Functioning in Patients with Major Depressive Disorder: Systematic Review and Meta-Analysis of Double-Blind, Placebo-Controlled RCTs

Walter H, Haaf R, Köhler S. Therapiemöglichkeiten der Depression nach Non-Response

Contact Info

Product

Resources

About