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Efficacy of Antidepressants for Depression in Alzheimer's Disease: Systematic Review and Meta-Analysis.
J Alzheimers Dis 2017; 58(3):725-733JA

Abstract

BACKGROUND

Depression is common in people with Alzheimer's disease (AD) affecting overall outcomes and decreasing quality of life. Although depression in AD is primarily treated with antidepressants, there are few randomized controlled trials (RCTs) assessing efficacy and results have been conflicting.

OBJECTIVES

To systematically review evidence on efficacy of antidepressant treatments for depression in AD.

METHODS

Systematic review and meta-analysis of double blind RCTs comparing antidepressants versus placebo for depression in AD. We searched MEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Controlled Trials Register and on line national and international registers. Primary outcomes were treatment response and depressive symptoms. Secondary outcomes were cognition, acceptability, and tolerability. Risk of bias was also assessed.

RESULTS

Seven studies met inclusion criteria. Three compared sertraline with placebo; one compared both sertraline and mirtazapine to placebo; imipramine, fluoxetine, and clomipramine were evaluated in one study each. In terms of response to treatment (6 studies, 297 patients treated with antidepressants and 223 with placebo), no statistically significant difference between antidepressants and placebo was found (odds ratio (OR) 1.95, 95% CI 0.97-3.92). We found no significant drug-placebo difference for depressive symptoms (5 studies, 311 patients, SMD -0.13; 95% CI -0.49 to 0.24). Overall quality of the evidence was moderate because of methodological limitations in studies and the small number of trials.

CONCLUSION

Despite the importance of depression in people with AD, few RCTs are available on efficacy of antidepressants, limiting clear conclusions of their potential role. There is a need for further high quality RCTs.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28505970

Citation

Orgeta, Vasiliki, et al. "Efficacy of Antidepressants for Depression in Alzheimer's Disease: Systematic Review and Meta-Analysis." Journal of Alzheimer's Disease : JAD, vol. 58, no. 3, 2017, pp. 725-733.
Orgeta V, Tabet N, Nilforooshan R, et al. Efficacy of Antidepressants for Depression in Alzheimer's Disease: Systematic Review and Meta-Analysis. J Alzheimers Dis. 2017;58(3):725-733.
Orgeta, V., Tabet, N., Nilforooshan, R., & Howard, R. (2017). Efficacy of Antidepressants for Depression in Alzheimer's Disease: Systematic Review and Meta-Analysis. Journal of Alzheimer's Disease : JAD, 58(3), pp. 725-733. doi:10.3233/JAD-161247.
Orgeta V, et al. Efficacy of Antidepressants for Depression in Alzheimer's Disease: Systematic Review and Meta-Analysis. J Alzheimers Dis. 2017;58(3):725-733. PubMed PMID: 28505970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of Antidepressants for Depression in Alzheimer's Disease: Systematic Review and Meta-Analysis. AU - Orgeta,Vasiliki, AU - Tabet,Naji, AU - Nilforooshan,Ramin, AU - Howard,Robert, PY - 2017/5/17/pubmed PY - 2018/3/22/medline PY - 2017/5/17/entrez KW - Alzheimer’s disease KW - Antidepressants KW - depression KW - effectiveness KW - meta-analysis KW - randomized controlled trials SP - 725 EP - 733 JF - Journal of Alzheimer's disease : JAD JO - J. Alzheimers Dis. VL - 58 IS - 3 N2 - BACKGROUND: Depression is common in people with Alzheimer's disease (AD) affecting overall outcomes and decreasing quality of life. Although depression in AD is primarily treated with antidepressants, there are few randomized controlled trials (RCTs) assessing efficacy and results have been conflicting. OBJECTIVES: To systematically review evidence on efficacy of antidepressant treatments for depression in AD. METHODS: Systematic review and meta-analysis of double blind RCTs comparing antidepressants versus placebo for depression in AD. We searched MEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Controlled Trials Register and on line national and international registers. Primary outcomes were treatment response and depressive symptoms. Secondary outcomes were cognition, acceptability, and tolerability. Risk of bias was also assessed. RESULTS: Seven studies met inclusion criteria. Three compared sertraline with placebo; one compared both sertraline and mirtazapine to placebo; imipramine, fluoxetine, and clomipramine were evaluated in one study each. In terms of response to treatment (6 studies, 297 patients treated with antidepressants and 223 with placebo), no statistically significant difference between antidepressants and placebo was found (odds ratio (OR) 1.95, 95% CI 0.97-3.92). We found no significant drug-placebo difference for depressive symptoms (5 studies, 311 patients, SMD -0.13; 95% CI -0.49 to 0.24). Overall quality of the evidence was moderate because of methodological limitations in studies and the small number of trials. CONCLUSION: Despite the importance of depression in people with AD, few RCTs are available on efficacy of antidepressants, limiting clear conclusions of their potential role. There is a need for further high quality RCTs. SN - 1875-8908 UR - https://www.unboundmedicine.com/medline/citation/28505970/Efficacy_of_Antidepressants_for_Depression_in_Alzheimer's_Disease:_Systematic_Review_and_Meta_Analysis_ L2 - https://content.iospress.com/openurl?genre=article&id=doi:10.3233/JAD-161247 DB - PRIME DP - Unbound Medicine ER -