Antidepressants are effective for depression in physically ill people

Clinical question: 
How effective are antidepressants for depression in patients with a physical illness?
Bottom line: 
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
Caveat: 
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
Context: 
Antidepressants are effective in the treatment of depression in physically healthy populations, but there is less clarity regarding their use in physically ill patients.
Review CD#: 
CD007503
PEARLS No: 
257
Date: 
May, 2010
Authored by: 
Brian R McAvoy