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Systematic review and meta-analysis of augmentation and combination treatments for early-stage treatment-resistant depression
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 fir...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076341/ https://www.ncbi.nlm.nih.gov/pubmed/35861202 http://dx.doi.org/10.1177/02698811221104058 |
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author | Scott, Fraser Hampsey, Elliot Gnanapragasam, Sam Carter, Ben Marwood, Lindsey Taylor, Rachael W Emre, Cansu Korotkova, Lora Martín-Dombrowski, Jonatan Cleare, Anthony J Young, Allan H Strawbridge, Rebecca |
author_facet | Scott, Fraser Hampsey, Elliot Gnanapragasam, Sam Carter, Ben Marwood, Lindsey Taylor, Rachael W Emre, Cansu Korotkova, Lora Martín-Dombrowski, Jonatan Cleare, Anthony J Young, Allan H Strawbridge, Rebecca |
author_sort | Scott, Fraser |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10076341 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-100763412023-04-07 Systematic review and meta-analysis of augmentation and combination treatments for early-stage treatment-resistant depression Scott, Fraser Hampsey, Elliot Gnanapragasam, Sam Carter, Ben Marwood, Lindsey Taylor, Rachael W Emre, Cansu Korotkova, Lora Martín-Dombrowski, Jonatan Cleare, Anthony J Young, Allan H Strawbridge, Rebecca J Psychopharmacol Original Papers 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. SAGE Publications 2022-07-21 2023-03 /pmc/articles/PMC10076341/ /pubmed/35861202 http://dx.doi.org/10.1177/02698811221104058 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Papers Scott, Fraser Hampsey, Elliot Gnanapragasam, Sam Carter, Ben Marwood, Lindsey Taylor, Rachael W Emre, Cansu Korotkova, Lora Martín-Dombrowski, Jonatan Cleare, Anthony J Young, Allan H Strawbridge, Rebecca Systematic review and meta-analysis of augmentation and combination treatments for early-stage treatment-resistant depression |
title | Systematic review and meta-analysis of augmentation and combination
treatments for early-stage treatment-resistant depression |
title_full | Systematic review and meta-analysis of augmentation and combination
treatments for early-stage treatment-resistant depression |
title_fullStr | Systematic review and meta-analysis of augmentation and combination
treatments for early-stage treatment-resistant depression |
title_full_unstemmed | Systematic review and meta-analysis of augmentation and combination
treatments for early-stage treatment-resistant depression |
title_short | Systematic review and meta-analysis of augmentation and combination
treatments for early-stage treatment-resistant depression |
title_sort | systematic review and meta-analysis of augmentation and combination
treatments for early-stage treatment-resistant depression |
topic | Original Papers |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076341/ https://www.ncbi.nlm.nih.gov/pubmed/35861202 http://dx.doi.org/10.1177/02698811221104058 |
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