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

Köhler-Forsberg, Ole; Stiglbauer, Victoria; Brasanac, Jelena; Chae, Woo Ri; Wagener, Frederike; Zimbalski, Kim; Jefsen, Oskar H.; Liu, Shuyan; Seals, Malik R.; Gamradt, Stefanie; Correll, Christoph U.; Gold, Stefan M.; Otte, Christian

doi:10.1001/jamapsychiatry.2023.2983

Cited by 10 publications

(5 citation statements)

References 93 publications

(107 reference statements)

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“…The findings also suggest that pharmacotherapy of MDD is safe for the short-term treatment of MDD. This is consistent with previous findings ( 1 ). On the other hand, from the long-term perspective, the psychoeducation gains importance as a tool to improve the overall functioning, adherence to treatment, and relapse prevention.…”

Section: Discussionsupporting

confidence: 94%

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In-person psychoeducational intervention to reduce rehospitalizations and improve the clinical course of major depressive disorder: a non-randomized pilot study

Breznoscakova,

Pallayova,

Izakova

et al. 2024

Front. Psychiatry

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BackgroundEmerging issues in the management of major depressive disorder (MDD) comprise a nonadherence to treatment and treatment failures, depressive recurrence and relapses, misidentification of incoming exacerbated phases and consequently, a chronification of depression. While antidepressant drugs constitute the standard of care for MDD, effective psychosocial interventions are needed to reduce rehospitalizations and other adverse events. The present study primarily investigated the effects and impact of implementing a structured psychoeducational intervention on the clinical course of MDD.MethodsA non-randomized comparative, pragmatic, pilot, single-center study of adults with nonpsychotic moderate or severe episode of MDD recently discharged from a psychiatric hospitalization. The consecutive subjects were allocated either to the intervention group (N=49) or to the attention control group (N=47), based on their preference. The psychoeducational intervention was based on a modified Munoz’s Depression Prevention Course. Subjects were followed up prospectively for two years.ResultsThe absolute changes in Beck anxiety inventory scale, Zung’s depression questionnaire, and Montgomery and Äsberg depression rating scale (MADRS) total scores at 6-month follow-up were comparable between the two groups. There were lower rates of the rehospitalization within one year (2.1% vs. 16.7%; P<0.001) and less rehospitalizations after one year (6.3% vs. 25%; P<0.001), lower rates of the ongoing sickness absence (11.5% vs. 29.2%; P<0.001), less persons with disability due to MDD at 1-year follow-up (1% vs. 11.5%; P=0.002), and less nonadherent subjects who self-discontinued treatment (6.3% vs. 28.1%; P<0.001) among participants in the intervention group compared to the control group. The disability due to MDD at 1-year follow-up was predicted by the absence of the psychoeducational intervention (P=0.002) and by the MADRS total score at 6-month follow-up (OR 1.10; 95% CI 1.003–1.195; P=0.044). Qualitative data indicated the intervention was desired and appreciated by the participants, as well as being practical to implement in Slovakian clinical settings.ConclusionThe results suggest the psychoeducational intervention based on a modified Munoz’s Depression Prevention Course has beneficial effects in adults with MDD recently discharged from a psychiatric hospitalization. The findings implicate the psychoeducational intervention may offer a new approach to the prevention of depressive relapses.

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Section: Discussionsupporting

confidence: 94%

“…The treatment of depression is multifaceted and usually involves a combination of pharmacological and non-pharmacological interventions. Nowadays, antidepressant treatment is effective, safe, and available ( 1 ). Yet, it is time-consuming, financially challenging, and human demanding.…”

Section: Introductionmentioning

confidence: 99%

In-person psychoeducational intervention to reduce rehospitalizations and improve the clinical course of major depressive disorder: a non-randomized pilot study

Breznoscakova,

Pallayova,

Izakova

et al. 2024

Front. Psychiatry

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“…Meta-analyses have reported that conventional depression treatments, both medications and psychotherapy, had medium effect sizes in people with chronic medical illness (SMD for antidepressants vs placebo, 0.42 [95% CI, 0.30-0.54]; SMD for psychotherapy vs no psychotherapy, 0.62 [95% CI, 0.52-0.79]), people who have experienced childhood trauma (SMD for antidepressants or psychotherapy vs placebo or no psychotherapy, 0.61 [95% CI, 0.29-0.92]), and those recently bereaved (SMD for psychotherapy vs no psychotherapy, 0.35 [95% CI, 0.08-0.62]) …”

Section: Discussionmentioning

confidence: 99%

Management of Depression in Adults

Simon,

Moise,

Mohr

2024

JAMA

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ImportanceApproximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women.ObservationsMajor depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]).Conclusions and RelevanceEffective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.

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“…Next, to prevent duplication of data, a matrix containing all eligible systematic reviews/meta-analyses for each category of mental disorder was created. Where there were multiple eligible systematic reviews/meta-analyses for the same disorder and treatment, we preferentially included meta-analyses, and if multiple eligible meta-analyses remained, then we included the one containing the largest number of studies for the same disorder and treatment, in line with recent umbrella reviews [46,47].…”

Section: Methodsmentioning

confidence: 99%

Placebo effects in randomized trials of pharmacological and neurostimulation interventions for mental disorders: An umbrella review

Huneke,

Amin,

Baldwin

et al. 2024

Mol Psychiatry

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There is a growing literature exploring the placebo response within specific mental disorders, but no overarching quantitative synthesis of this research has analyzed evidence across mental disorders. We carried out an umbrella review of meta-analyses of randomized controlled trials (RCTs) of biological treatments (pharmacotherapy or neurostimulation) for mental disorders. We explored whether placebo effect size differs across distinct disorders, and the correlates of increased placebo effects. Based on a pre-registered protocol, we searched Medline, PsycInfo, EMBASE, and Web of Knowledge up to 23.10.2022 for systematic reviews and/or meta-analyses reporting placebo effect sizes in psychopharmacological or neurostimulation RCTs. Twenty meta-analyses, summarising 1,691 RCTs involving 261,730 patients, were included. Placebo effect size varied, and was large in alcohol use disorder (g = 0.90, 95% CI [0.70, 1.09]), depression (g = 1.10, 95% CI [1.06, 1.15]), restless legs syndrome (g = 1.41, 95% CI [1.25, 1.56]), and generalized anxiety disorder (d = 1.85, 95% CI [1.61, 2.09]). Placebo effect size was small-to-medium in obsessive-compulsive disorder (d = 0.32, 95% CI [0.22, 0.41]), primary insomnia (g = 0.35, 95% CI [0.28, 0.42]), and schizophrenia spectrum disorders (standardized mean change = 0.33, 95% CI [0.22, 0.44]). Correlates of larger placebo response in multiple mental disorders included later publication year (opposite finding for ADHD), younger age, more trial sites, larger sample size, increased baseline severity, and larger active treatment effect size. Most (18 of 20) meta-analyses were judged ‘low’ quality as per AMSTAR-2. Placebo effect sizes varied substantially across mental disorders. Future research should explore the sources of this variation. We identified important gaps in the literature, with no eligible systematic reviews/meta-analyses of placebo response in stress-related disorders, eating disorders, behavioural addictions, or bipolar mania.

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

Cited by 10 publications

References 93 publications

In-person psychoeducational intervention to reduce rehospitalizations and improve the clinical course of major depressive disorder: a non-randomized pilot study

In-person psychoeducational intervention to reduce rehospitalizations and improve the clinical course of major depressive disorder: a non-randomized pilot study

Management of Depression in Adults

Placebo effects in randomized trials of pharmacological and neurostimulation interventions for mental disorders: An umbrella review

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