Antidepressants for treatment of depression in primary care

A systematic review and meta-analysis

Bruce Arroll (Lead / Corresponding author), Weng Yee Chin, Waldron Martis, Felicity Goodyear-Smith, Vicki Mount, Douglas Kingsford, Stephen Humm, Grant Blashki, Stephen A. (Steve) MacGillivray

Research output: Contribution to journalArticle

9 Citations (Scopus)
97 Downloads (Pure)

Abstract

INTRODUCTION: Evidence for the effectiveness of drug treatment for depression in primary care settings remains limited, with little information on newer antidepressant classes. AIM: To update an earlier Cochrane review on the effectiveness of antidepressants in primary care to include newer antidepressant classes, and to examine the efficacy of individual agents.

METHODS: Selection criteria included antidepressant studies with a randomly assigned placebo group where half or more subjects were recruited from primary care. The Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) group searched multiple databases to identify eligible studies. Data extraction was performed independently by two reviewers. Data were analysed using Revman version 5.3.5.

RESULTS:  In total, 17 papers and 22 comparisons were included for analysis. Significant benefits in terms of response were found for tricyclic antidepressants (TCA) with a relative risk (RR) = 1.23 (95% CI, 1.01-1.48), and serotonin selective reuptake inhibitors (SSRI) with a RR = 1.33 (95% CI, 1.20-1.48). Mianserin was effective for continuous outcomes. Numbers needed to treat (NNT) for TCA = 8.5; SSRI = 6.5; and venlafaxine = 6. Most studies were industry-funded and of a brief duration (≤ 8 weeks). There was evidence of publication bias. There were no studies comparing newer antidepressants against placebo.

CONCLUSION: Antidepressants such as TCA, SSRI, SNRI (serotonin-norepinephrine reuptake inhibitor) and NaSSA (noradrenergic and specific serotonergic antidepressant) classes appear to be effective in primary care when compared with placebo. However, in view of the potential for publication bias and that only four studies were not funded by industry, caution is needed when considering their use in primary care.

Original languageEnglish
Pages (from-to)325-334
Number of pages10
JournalJournal of Primary Health Care
Volume8
Issue number4
Early online date21 Dec 2016
DOIs
Publication statusPublished - 21 Dec 2016

Fingerprint

Antidepressive Agents
Meta-Analysis
Primary Health Care
Depression
Tricyclic Antidepressive Agents
Serotonin Uptake Inhibitors
Publication Bias
Placebos
Therapeutics
Industry
Mianserin
Numbers Needed To Treat
Anxiety Disorders
Patient Selection
Databases
Pharmaceutical Preparations

Keywords

  • Antidepressant agents
  • Clinical trial
  • General practice
  • Meta-analysis
  • Placebos
  • Primary health care

Cite this

Arroll, Bruce ; Chin, Weng Yee ; Martis, Waldron ; Goodyear-Smith, Felicity ; Mount, Vicki ; Kingsford, Douglas ; Humm, Stephen ; Blashki, Grant ; MacGillivray, Stephen A. (Steve). / Antidepressants for treatment of depression in primary care : A systematic review and meta-analysis. In: Journal of Primary Health Care. 2016 ; Vol. 8, No. 4. pp. 325-334.
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abstract = "INTRODUCTION: Evidence for the effectiveness of drug treatment for depression in primary care settings remains limited, with little information on newer antidepressant classes. AIM: To update an earlier Cochrane review on the effectiveness of antidepressants in primary care to include newer antidepressant classes, and to examine the efficacy of individual agents.METHODS: Selection criteria included antidepressant studies with a randomly assigned placebo group where half or more subjects were recruited from primary care. The Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) group searched multiple databases to identify eligible studies. Data extraction was performed independently by two reviewers. Data were analysed using Revman version 5.3.5.RESULTS:  In total, 17 papers and 22 comparisons were included for analysis. Significant benefits in terms of response were found for tricyclic antidepressants (TCA) with a relative risk (RR) = 1.23 (95{\%} CI, 1.01-1.48), and serotonin selective reuptake inhibitors (SSRI) with a RR = 1.33 (95{\%} CI, 1.20-1.48). Mianserin was effective for continuous outcomes. Numbers needed to treat (NNT) for TCA = 8.5; SSRI = 6.5; and venlafaxine = 6. Most studies were industry-funded and of a brief duration (≤ 8 weeks). There was evidence of publication bias. There were no studies comparing newer antidepressants against placebo.CONCLUSION: Antidepressants such as TCA, SSRI, SNRI (serotonin-norepinephrine reuptake inhibitor) and NaSSA (noradrenergic and specific serotonergic antidepressant) classes appear to be effective in primary care when compared with placebo. However, in view of the potential for publication bias and that only four studies were not funded by industry, caution is needed when considering their use in primary care.",
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Arroll, B, Chin, WY, Martis, W, Goodyear-Smith, F, Mount, V, Kingsford, D, Humm, S, Blashki, G & MacGillivray, SAS 2016, 'Antidepressants for treatment of depression in primary care: A systematic review and meta-analysis', Journal of Primary Health Care, vol. 8, no. 4, pp. 325-334. https://doi.org/10.1071/HC16008

Antidepressants for treatment of depression in primary care : A systematic review and meta-analysis. / Arroll, Bruce (Lead / Corresponding author); Chin, Weng Yee; Martis, Waldron; Goodyear-Smith, Felicity; Mount, Vicki; Kingsford, Douglas; Humm, Stephen; Blashki, Grant; MacGillivray, Stephen A. (Steve).

In: Journal of Primary Health Care, Vol. 8, No. 4, 21.12.2016, p. 325-334.

Research output: Contribution to journalArticle

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T1 - Antidepressants for treatment of depression in primary care

T2 - A systematic review and meta-analysis

AU - Arroll, Bruce

AU - Chin, Weng Yee

AU - Martis, Waldron

AU - Goodyear-Smith, Felicity

AU - Mount, Vicki

AU - Kingsford, Douglas

AU - Humm, Stephen

AU - Blashki, Grant

AU - MacGillivray, Stephen A. (Steve)

N1 - We wish to thank the University of Auckland Summer Student Research programme for funding Waldron Martis.

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Y1 - 2016/12/21

N2 - INTRODUCTION: Evidence for the effectiveness of drug treatment for depression in primary care settings remains limited, with little information on newer antidepressant classes. AIM: To update an earlier Cochrane review on the effectiveness of antidepressants in primary care to include newer antidepressant classes, and to examine the efficacy of individual agents.METHODS: Selection criteria included antidepressant studies with a randomly assigned placebo group where half or more subjects were recruited from primary care. The Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) group searched multiple databases to identify eligible studies. Data extraction was performed independently by two reviewers. Data were analysed using Revman version 5.3.5.RESULTS:  In total, 17 papers and 22 comparisons were included for analysis. Significant benefits in terms of response were found for tricyclic antidepressants (TCA) with a relative risk (RR) = 1.23 (95% CI, 1.01-1.48), and serotonin selective reuptake inhibitors (SSRI) with a RR = 1.33 (95% CI, 1.20-1.48). Mianserin was effective for continuous outcomes. Numbers needed to treat (NNT) for TCA = 8.5; SSRI = 6.5; and venlafaxine = 6. Most studies were industry-funded and of a brief duration (≤ 8 weeks). There was evidence of publication bias. There were no studies comparing newer antidepressants against placebo.CONCLUSION: Antidepressants such as TCA, SSRI, SNRI (serotonin-norepinephrine reuptake inhibitor) and NaSSA (noradrenergic and specific serotonergic antidepressant) classes appear to be effective in primary care when compared with placebo. However, in view of the potential for publication bias and that only four studies were not funded by industry, caution is needed when considering their use in primary care.

AB - INTRODUCTION: Evidence for the effectiveness of drug treatment for depression in primary care settings remains limited, with little information on newer antidepressant classes. AIM: To update an earlier Cochrane review on the effectiveness of antidepressants in primary care to include newer antidepressant classes, and to examine the efficacy of individual agents.METHODS: Selection criteria included antidepressant studies with a randomly assigned placebo group where half or more subjects were recruited from primary care. The Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) group searched multiple databases to identify eligible studies. Data extraction was performed independently by two reviewers. Data were analysed using Revman version 5.3.5.RESULTS:  In total, 17 papers and 22 comparisons were included for analysis. Significant benefits in terms of response were found for tricyclic antidepressants (TCA) with a relative risk (RR) = 1.23 (95% CI, 1.01-1.48), and serotonin selective reuptake inhibitors (SSRI) with a RR = 1.33 (95% CI, 1.20-1.48). Mianserin was effective for continuous outcomes. Numbers needed to treat (NNT) for TCA = 8.5; SSRI = 6.5; and venlafaxine = 6. Most studies were industry-funded and of a brief duration (≤ 8 weeks). There was evidence of publication bias. There were no studies comparing newer antidepressants against placebo.CONCLUSION: Antidepressants such as TCA, SSRI, SNRI (serotonin-norepinephrine reuptake inhibitor) and NaSSA (noradrenergic and specific serotonergic antidepressant) classes appear to be effective in primary care when compared with placebo. However, in view of the potential for publication bias and that only four studies were not funded by industry, caution is needed when considering their use in primary care.

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