Moderation of antidepressant and placebo outcomes by baseline severity in late-life depression: A systematic review and meta-analysis.
J Affect Disord
; 181: 50-60, 2015 Aug 01.
Article
in En
| MEDLINE
| ID: mdl-25917293
ABSTRACT
BACKGROUND:
Baseline severity is a crucial moderator of trial outcomes in adult depression, with the advantage of antidepressants over placebo increasing as severity increases. However, this relationship has not been examined in late-life depression.METHODS:
PubMed, Embase, Web of Science, PsycINFO, and Cochrane were searched for studies published through September 2014. Randomized, acute phase, and double-blind studies comparing an antidepressant group with a placebo group in depressed elderly patients were included.RESULTS:
Nineteen studies met all inclusion criteria. Within-group effect sizes revealed significant improvement in antidepressant groups (g=1.35, p<.000), as well as in placebo groups (g=.96, p<.000). Change in depressive symptoms assessed by Hamilton Depression Rating Scale (HDRS) was moderated by baseline severity in antidepressant groups (Z=2.67, p=.008) and placebo groups (Z=4.46, p<.000). However, this would be expected as a result of regression toward the mean, and mean differences between groups did not increase (r=.19, p=.469) as a function of baseline severity.LIMITATIONS:
Limited to published data and information was only analyzed at the level of treatment groups.CONCLUSION:
Baseline severity was not associated with an antidepressant-placebo difference and placebo responses are large in the treatment of depressed elderly people. We propose a stepwise approach, i.e., to initially offer elderly depressed patients psychosocial interventions and only consider antidepressants if patients do not respond.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Placebo Effect
/
Depression
/
Late Onset Disorders
/
Antidepressive Agents
Type of study:
Clinical_trials
/
Systematic_reviews
Limits:
Humans
Language:
En
Year:
2015
Type:
Article