title: Pharmacological interventions for people with depression and chronic physical health problems: systematic review and meta-analyses of safety and efficacy.
abstract: BACKGROUND
  Antidepressant drugs are widely used in the treatment of depression in people with chronic physical health problems.
  
  
  OBJECTIVE
  To examine evidence related to efficacy, tolerability and safety of antidepressants for people with depression and with chronic physical health problems.
  
  
  METHODS
  Meta-analyses of randomised controlled efficacy trials of antidepressants in depression in chronic physical health conditions. Systematic review of safety studies.
  
  
  RESULTS
  Sixty-three studies met inclusion criteria (5794 participants). In placebo-controlled studies, antidepressants showed a significant advantage in respect to remission and/or response: selective serotonin reuptake inhibitors (SSRIs) risk ratio (RR) = 0.81 (95% CI 0.73-0.91) for remission, RR = 0.83 (95% CI 0.71-0.97) for response; tricyclics RR = 0.70 (95% CI 0.40-1.25 (not significant)) for remission, RR = 0.55 (95% 0.43-0.70) for response. Both groups of drugs were less well tolerated than placebo (leaving study early due to adverse effects) for SSRIs RR = 1.80 (95% CI 1.16-2.78), for tricyclics RR = 2.00 (95% CI 0.99-3.57). Only SSRIs were shown to improve quality of life. Direct comparisons of SSRIs and tricyclics revealed no advantage for either group for remission, response, effect size or tolerability. Effectiveness studies suggest a neutral or beneficial effect on mortality for antidepressants in participants with recent myocardial infarction.
  
  
  CONCLUSIONS
  Antidepressants are efficacious and safe in the treatment of depression occurring in the context of chronic physical health problems. The SSRIs are probably the antidepressants of first choice given their demonstrable effect on quality of life and their apparent safety in cardiovascular disease.
authors.affiliation: Pharmacy Department, South London and Maudsley NHS Foundation Trust, Pharmaceutical Sciences Division, King’s College London, UK. David.Taylor@slam.nhs.uk
authors.forename: David
authors.initials: D
authors.lastname: Taylor
authors.forename: Nicholas
authors.initials: N
authors.lastname: Meader
authors.forename: Victoria
authors.initials: V
authors.lastname: Bird
authors.forename: Steve
authors.initials: S
authors.lastname: Pilling
authors.forename: Francis
authors.initials: F
authors.lastname: Creed
authors.forename: David
authors.initials: D
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000145:classification / Q000627:therapeutic use*; D001294:Attitude to Health; D002908:Chronic Disease / Q000188:drug therapy*; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors