Wellness Check: Mental Health
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.
1. In this retrospective cohort study, patients with a history of depression, anxiety, or both did not have a significant increase in emergency department visits following bariatric surgery compared to those without.
2. Furthermore, patients with a history of depression and/or anxiety also did not have an increase in hospital readmissions in the first year post-bariatric surgery compared to those without.
Evidence Rating Level: 2 (Good)
Patients who undergo bariatric surgery have a high prevalence of preoperative mental illness. Although patients with bipolar disorder and schizophrenia experience more emergency department (ED) visits following bariatric surgery, it is unclear if this relationship exists in bariatric surgery patients with other mental health disorders. This study aimed to assess whether patients with a history of anxiety and/or depression experience more ED encounters and hospital readmissions following bariatric surgery than those without either illness at an institution with a robust preoperative multidisciplinary program.
The study included 1,113 patients who underwent bariatric surgery between March 2012 and December 2019. Patients were included if they had undergone a sleeve gastrectomy or gastric bypass during the study period. Information on depression, anxiety, patient demographics, ED encounters, and hospital readmissions was obtained from a review of electronic medical records. The multidisciplinary program includes weekly meetings between surgeons and psychologists to evaluate patient readiness for surgery and provide necessary treatment for mental illnesses. The primary outcome was the difference in ED encounters and hospital readmissions between those with and without depression and/or anxiety.
The results demonstrated that patients with a history of depression and/or anxiety did not have a significant increase in ED visits nor hospital readmissions in the first year following bariatric surgery compared to those who did not have either disorder. Furthermore, those who received sleeve gastrectomy experienced fewer ED visits and hospital readmissions compared to other bariatric surgeries. However, the study was limited by the confounding factor of the preoperative multidisciplinary program, which limits the generalizability of these findings to other bariatric surgery patients with anxiety and/or depression. Nonetheless, this study provided evidence to suggest that patients with anxiety and/or depression do not experience higher rates of readmission and ED visits following bariatric surgery than those without.
1. In this longitudinal cohort study, in midlife women with high adverse childhood experiences and high current life stressors, there was an association between C-reactive protein (CRP) and higher odds of having clinically significant depression symptoms.
2. However, this interaction was not significant for other inflammatory markers, including interleukin-6 (IL-6), interleukin-1-beta (IL-1β), or tumor necrosis factor-alpha (TNF-α).
Evidence Rating Level: 2 (Good)
Inflammatory markers, such as C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-1-beta (IL-1β), and tumor necrosis factor-alpha (TNF-α) demonstrate variable relationships with depression. Evidence shows that these inflammatory markers are upregulated in only a subset of patients with depression. Further research has suggested that other factors, such as adverse child experiences and current life stressors, may mediate the relationship between inflammatory markers in depression, though this relationship remains unclear. This relationship is even more unclear during the menopausal transition. Thus, this study set out to determine whether adverse childhood experiences and current life stressors affect the relationship between inflammatory markers and depression in women at midlife.
This study included 142 participants from the Penn Ovarian Ageing Study cohort who were premenopausal and between the ages of 35 and 47 at the beginning of the study. Patients were included if they had a uterus and at least one ovary. Participants were excluded if they experienced recent substance abuse, used psychotropics or hormonal contraception, or had health problems that affected hormone function. Participants were assessed annually over a 16-year period and provided information on demographics, health status, and their menstrual cycle. Blood was also collected annually for analysis of inflammatory markers. Information on stressful life events was obtained from year 5 onwards. Information on adverse childhood experiences was obtained at the end of the study. Depression symptom severity was determined using the Centre for Epidemiologic Studies Depression (CESD) scale. The primary outcome was the association between inflammatory markers and clinically significant depression symptoms, with a focus on the impact of adverse childhood experiences and current life stressors.
The results demonstrated that in women who had high adverse childhood experiences and high current life stressors, higher CRP was associated with significantly higher odds of clinically significant depression. However, this association was not seen for other inflammatory markers, including IL-6, IL-1β, and TNF-α. Furthermore, there was no association between CRP and clinically significant depression in women with low adverse childhood events or low current life stressors. However, the study was limited by the correlative study design, which prohibited the assessment of the causal nature of high CRP levels. Nonetheless, the study demonstrated that life stressors and adverse childhood events may mediate the relationship between some inflammatory markers and depressive symptoms in midlife women.
Image: PD
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