Systematic review and meta-analysis of augmentation and combination treatments for early-stage treatment-resistant depression.
J Psychopharmacol
; 37(3): 268-278, 2023 03.
Article
em En
| MEDLINE
| ID: mdl-35861202
ABSTRACT
BACKGROUND:
Major depressive disorder (MDD) is a highly burdensome health condition, for which there are numerous accepted pharmacological and psychological interventions. Adjunctive treatment (augmentation/combination) is recommended for the ~50% of MDD patients who do not adequately respond to first-line treatment. We aimed to evaluate the current evidence for concomitant approaches for people with early-stage treatment-resistant depression (TRD; defined below).METHODS:
We systematically searched Medline and Institute for Scientific Information Web of Science to identify randomised controlled trials of adjunctive treatment of ⩾10 adults with MDD who had not responded to ⩾1 adequate antidepressant. The cochrane risk of bias (RoB) tool was used to assess study quality. Pre-post treatment meta-analyses were performed, allowing for comparison across heterogeneous study designs independent of comparator interventions.RESULTS:
In total, 115 trials investigating 48 treatments were synthesised. The mean intervention duration was 9 weeks (range 5 days to 18 months) with most studies assessed to have low (n = 57) or moderate (n = 51) RoB. The highest effect sizes (ESs) were from cognitive behavioural therapy (ES = 1.58, 95% confidence interval (CI) 1.09-2.07), (es)ketamine (ES = 1.48, 95% CI 1.23-1.73) and risperidone (ES = 1.42, 95% CI 1.29-1.61). Only aripiprazole and lithium were examined in ⩾10 studies. Pill placebo (ES = 0.89, 95% CI 0.81-0.98) had a not inconsiderable ES, and only six treatments' 95% CIs did not overlap with pill placebo's (aripiprazole, (es)ketamine, mirtazapine, olanzapine, quetiapine and risperidone). We report marked heterogeneity between studies for almost all analyses.CONCLUSIONS:
Our findings support cautious optimism for several augmentation strategies; although considering the high prevalence of TRD, evidence remains inadequate for each treatment option.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Transtorno Depressivo Maior
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Ketamina
Tipo de estudo:
Clinical_trials
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Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Limite:
Adult
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Humans
Idioma:
En
Revista:
J Psychopharmacol
Ano de publicação:
2023
Tipo de documento:
Article