Many people with medical conditions such as heart disease and cancer also experience symptoms of depression. A report published yesterday in JAMA Psychiatry suggests antidepressants are as safe and effective for people with comorbid depression as those with depression only.
“It is important to screen for and manage comorbid depression in patients with medical diseases, and clinicians should choose treatments based on patient preferences and the antidepressant’s risk-benefit ratio,” wrote Ole Köhler-Forsberg, M.D., Ph.D., D.M.Sc., of Aarhus University Hospital-Psychiatry in Denmark.
The researchers identified 176 systematic reviews published before March 31, 2003, that included patients who had been diagnosed with a medical disorder and randomized to receive antidepressants or placebo for comorbid depression. Most of the systematic reviews involved patients with neurological (n = 79), cardiological (n = 18), and oncological (n = 20) diseases.
Köhler-Forsberg and colleagues narrowed in on 52 meta-analyses involving 27 medical diseases. They examined antidepressant efficacy as well as reports of patients discontinuing their antidepressants, including for adverse effects.
While patients assigned to antidepressants generally showed greater improvements in depression symptoms compared with those taking placebo, these improvements varied according to the comorbid medical condition examined. The researchers also found that patients assigned to antidepressants were more likely to discontinue taking the medication than those taking placebo.
Köhler-Forsberg and colleagues wrote that their analysis suggests the efficacy of antidepressants (relative to placebo) in patients with depression and comorbid medical diseases is comparable to their efficacy in people with depression alone.
“Future large, high-quality [trials] should include head-to-head comparisons between antidepressants to expand the knowledge on potential differences in efficacy and safety between antidepressants for depression comorbid with medical diseases and to allow more specific treatment recommendations for distinct medical diseases,” Köhler-Forsberg and colleagues concluded.
For related information, see the Psychiatric News article “Antidepressants May Lower Heart Attack Risk in Diabetes.”
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