Universität zu Köln

Henssler, Jonathan ORCID: 0000-0001-8123-5853, Kurschus, Mona, Franklin, Jeremy ORCID: 0000-0003-1536-0925, Bschor, Tom and Baethge, Christopher (2018). Long-Term Acute-Phase Treatment With Antidepressants, 8 Weeks and Beyond: A Systematic Review and Meta-Analysis of Randomized, Placebo-Controlled Trials. J. Clin. Psychiatry, 79 (1). S. 60 - 87. MEMPHIS: PHYSICIANS POSTGRADUATE PRESS. ISSN 1555-2101

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Abstract

Objective: In clinical practice, acute antidepressant treatment is often applied for several months until remission is achieved. However, data on treatment outcomes beyond 8 weeks are sparse and no systematic review exists to date. This study aims at assessing efficacy and tolerability of antidepressants compared to placebo in acute treatment at and beyond 8 weeks. Data Sources: MEDLINE, Embase, PsycINFO, and CENTRAL databases were systematically searched through March 2014 using generic terms for depressive and affective disorders combined with generic terms for individual drugs and placebo. Study Selection: Double- blind, randomized, placebo- controlled studies of 8 weeks or more comparing antidepressant monotherapy to placebo in adult patients with acute depressive disorder. Data Extraction: Data extraction and synthesis followed guidelines of the Cochrane Collaboration. All data were extracted independently by 2 reviewers. Primary outcome was standardized mean difference (SMD) between antidepressant and placebo; secondary outcomes were response, remission, and dropouts. Results: Of 6,043 articles screened, we selected 104 studies that met criteria and included 35,052 patients. Active treatment was statistically significantly superior to placebo, with consistent effect sizes (SMD [95% CL]) after 8, 12, 16, 20, and 24 weeks: 0.27 (0.24, 0.30), 0.34 (0.25, 0.43), 0.24 (0.09, 0.40), 0.31 (0.12, 0.51), and 0.34 (0.18, 0.50), respectively. Results remained stable across secondary outcomes and subgroup and sensitivity analyses. Conclusions: Effect sizes of antidepressant monotherapy compared to placebo seem to be stable over 6 months. These results challenge the assumption that long- term antidepressant effects are due to the natural course of the disorder rather than to a pharmacologic effect.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Henssler, Jonathan UNSPECIFIED orcid.org/0000-0001-8123-5853 UNSPECIFIED Kurschus, Mona UNSPECIFIED UNSPECIFIED UNSPECIFIED Franklin, Jeremy UNSPECIFIED orcid.org/0000-0003-1536-0925 UNSPECIFIED Bschor, Tom UNSPECIFIED UNSPECIFIED UNSPECIFIED Baethge, Christopher UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-202508
DOI:	10.4088/JCP.15r10545
Journal or Publication Title:	J. Clin. Psychiatry
Volume:	79
Number:	1
Page Range:	S. 60 - 87
Date:	2018
Publisher:	PHYSICIANS POSTGRADUATE PRESS
Place of Publication:	MEMPHIS
ISSN:	1555-2101
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MAJOR DEPRESSIVE DISORDER; LEVOMILNACIPRAN SUSTAINED-RELEASE; SEROTONIN REUPTAKE INHIBITORS; DOUBLE-BLIND; GENERAL-PRACTICE; 40 MG; EFFICACY; AMITRIPTYLINE; SAFETY; FLUOXETINE Multiple languages Psychology, Clinical; Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/20250