Antidepressants for major depressive disorder in patients with a co-morbid axis-III disorder: a meta-analysis of patient characteristics and placebo response rates in randomized controlled trials

作者：Iovieno Nadia; Tedeschini Enrico^*; Ameral Victoria E; Rigatelli Marco; Papakostas George I

来源：International Clinical Psychopharmacology, 2011, 26(2): 69-74.

DOI：10.1097/YIC.0b013e328340775e

• antidepressant
• major depressive disorder
• medical co-morbidity
• placebo

The objective of this study is to assess whether the antidepressants are effective in treating major depressive disorder (MDD) in patients with a co-morbid axis-III disorder, and to compare the relative efficacy (vs. placebo) of antidepressants between these patients and those enrolled in general MDD trials. Medline/Pubmed publication databases were searched. We selected for randomized, double-blind, placebo-controlled trials of antidepressants for MDD, whether conducted in a general population, or in populations with an axis-III disorder. Antidepressants were more effective than placebo in patients with axis-III disorders overall [risk ratio for response (RR) = 1.42, P < 0.0001], as well as specifically for post-stroke (RR = 1.43, P = 0.04), human-immunodeficiency virus positive or acquired immunodeficiency syndrome (RR = 1.66, P = 0.005), but not cancer patients (RR = 1.26, P = 0.19). There was a trend for higher placebo response rates in studies, which did (41.2%) versus those which did not (37.7%) select for axis-III disorders (P = 0.06), and significantly higher antidepressant response rates in studies which did (57.4%) versus those which did not (53.5%) select for axis-III disorders (P = 0.01). Antidepressants are effective for MDD in patients who present with co-morbid axis-III disorders and as effective (vs. placebo) in this population as they are in the general MDD population. Higher general response rates observed in the co-morbid MDD population are intriguing, and require replication.

• 出版日期2011-3