How effective are antidepressants for depression in patients with a physical illness?
Antidepressants were more effective than placebo in treating
depression in physically ill patients. The superiority of antidepressants
over placebo was apparent within 4–5 weeks (NNT* 6) and
persisted after 18 weeks (NNT 7). Subgroup analysis showed both
tricyclic antidepressants (TCAs) and selective serotonin reuptake
inhibitors (SSRIs) were superior to placebo in treating depression
in physically ill patients. Antidepressants were associated
with increased rates of dry mouth (particularly TCAs) and sexual
dysfunction (particularly SSRIs) compared with placebo. There was
no evidence of a difference in drop-out between TCAs and SSRIs.
Subgroup analysis suggested TCAs, which are often considered
inappropriate for physically ill patients,1 are as effective and as
acceptable to patients as SSRIs. There are no grounds to recommend
a specific antidepressant on the basis of this review, which
included studies evaluating a total of 22 different drugs.
* NNT = number needed to treat to benefit 1 individual
At 6–8 weeks, there were more drop-outs among patients treated
with an antidepressant than among patients treated with placebo
(NNH**19), but no difference was observed at the other timepoints
assessed. Due to potential biases, such as selective
publication, small sample sizes and the variable methodological
quality of trials, it is likely the effect sizes obtained in this review
overestimate the efficacy of antidepressants.
** NNH = number needed to treat to cause harm in 1 individual
Antidepressants are effective in the treatment of depression in
physically healthy populations, but there is less clarity regarding
their use in physically ill patients.