title: Antidepressants for the treatment of depression in neurological disorders: a systematic review and meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  Despite the high prevalence of depression in people with neurological disorders, no previous study has sought to summarise existing evidence on the use of antidepressants in this population. A systematic review and meta-analysis was undertaken to determine whether antidepressants are more effective than placebo in the treatment of depression in neurological disorders, and whether any benefit is associated with improvement in function.
  
  
  METHODS
  Embase, Pubmed, Psycinfo and Cochrane trial registers were searched for randomised controlled trials (RCTs) comparing the efficacy of antidepressant and placebo in the treatment of depression in adults with a neurological disorder.
  
  
  RESULTS
  20 RCTs were included in the review, including patients with Parkinson's disease, multiple sclerosis, brain injury, epilepsy and stroke. Outcomes were analysed at four time points: 4-5 weeks, 6-8 weeks, 9-18 weeks and >18 weeks. The primary outcome was response to treatment at 6-8 weeks. The evidence favoured the use of antidepressants over placebo at all time points although pooled results were not statistically significant at all time points. At 6-8 weeks, antidepressant treatment was associated with a greater than twofold odds of remission (OR 2.23; 95% CI 1.54 to 3.23; number needed to treat=7). Fewer data were available for quality of life, and functional and cognitive outcomes, and there was little evidence of improvement with antidepressant treatment.
  
  
  CONCLUSIONS
  Antidepressants are effective for the treatment of depression in patients with neurological disorders but the evidence for the efficacy of antidepressants in improving quality of life, and functional and cognitive outcomes is inconclusive.
authors.affiliation: King’s College London, Department of Psychological Medicine, The Institute of Psychiatry, London, UK. annabel.price@kcl.ac.uk
authors.forename: Annabel
authors.initials: A
authors.lastname: Price
authors.forename: Lauren
authors.initials: L
authors.lastname: Rayner
authors.forename: Ewa
authors.initials: E
authors.lastname: Okon-Rocha
authors.forename: Alison
authors.initials: A
authors.lastname: Evans
authors.forename: Koravangattu
authors.initials: K
authors.lastname: Valsraj
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D009422:Nervous System Diseases / Q000523:psychology*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents