Antidepressants are effective in patients with comorbid depression and medical diseases

1. This umbrella systematic review and meta-analysis found that depression rating scale scores were significantly improved across medical diseases in patients with comorbid depression compared to placebo.

2. However, antidepressants showed the greatest effect for treating depression comorbid with myocardial infarction, functional chest pain, and coronary artery disease. They demonstrated the least effect for low back pain and traumatic brain injury.

Evidence Rating Level: 1 (Excellent)

Major depression disorder (MDD) is highly prevalent among individuals with other medical conditions. Although anti-depressants are the first-line treatment for MDD, most studies that investigate the safety and efficacy of anti-depressants exclude patients with other comorbidities. As such, the use of antidepressants in the treatment of comorbid depression in patients with other medical diseases is poorly understood. Therefore, this study aimed to assess the safety and efficacy of antidepressants in patients with medical conditions and comorbid depression.

Of 6,587 identified records, 176 systematic reviews (n=43 medical diseases) and 52 meta-analyses (n=27 medical diseases) were included from database inception to March 2023. Studies were included if they were systematic reviews of randomized controlled trials that investigated the treatment of comorbid depression and medical diseases with antidepressants compared to placebo or active control groups. Studies were if the efficacy and tolerability of antidepressants was not explored or if depression was comorbid with another mental disorder. The review was carried out according to PRISMA guidelines. The primary outcome was the efficacy of antidepressants in the treatment of comorbid depression, as determined by depression rating scale scores.

The results demonstrated that antidepressants were associated with significant improvements in depression rating scale scores compared to placebo. Antidepressants showed the greatest improvement in depressive symptoms for depression comorbid with myocardial infarction, functional chest pain, and coronary artery disease. Meanwhile, the smallest improvement was seen for depression comorbid with low back pain and traumatic brain injury. Antidepressants showed worse acceptability and tolerability than placebo but led to higher response rates and remission rates than placebo. However, the review was limited by the inclusion of studies without details on tolerability and acceptability, which may have impacted the results. Nonetheless, the study demonstrated that antidepressants are effective in treating depression comorbid with other medical conditions.

Click to read the study in JAMA Psychiatry

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