Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis

Bruce Arroll 1 , Weng-yee Chin 2 , Waldron Martis 1 , Felicity Goodyear-Smith 1 , Vicki Mount 3 , Douglas Kingsford 4 , Stephen Humm 5 , Grant Blashki 6 , Stephen MacGillivray 7
+ Author Affiliations
- Author Affiliations

1 Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand

2 Department of Family Medicine & Primary Care and Institute of Medical and Health Sciences Education, University of Hong Kong, Hong Kong

3 Auckland City Hospital, Grafton, Auckland, New Zealand

4 Chief Medical Information Officer & Executive Medical Director Interior Health Authority, Kelowna, British Columbia, Canada

5 Christchurch PsychMed, Christchurch, New Zealand

6 Department of General Practice, University of Melbourne, Melbourne, Australia

7 Evidence Synthesis Training and Research Group, Centre for Health and Related Research, University of Dundee, Dundee, Scotland

Correspondence to: Bruce Arroll, Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Email: bruce.arroll@auckland.ac.nz

Journal of Primary Health Care 8(4) 325-334 https://doi.org/10.1071/HC16008
Published: 21 December 2016

Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Abstract

INTRODUCTION: Evidence for the effectiveness of drug treatment for depression in primary care settings remains limited, with little information on newer antidepressant classes.

AIM: To update an earlier Cochrane review on the effectiveness of antidepressants in primary care to include newer antidepressant classes, and to examine the efficacy of individual agents.

METHODS: Selection criteria included antidepressant studies with a randomly assigned placebo group where half or more subjects were recruited from primary care. The Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) group searched multiple databases to identify eligible studies. Data extraction was performed independently by two reviewers. Data were analysed using Revman version 5.3.5.

RESULTS: In total, 17 papers and 22 comparisons were included for analysis. Significant benefits in terms of response were found for tricyclic antidepressants (TCA) with a relative risk (RR) = 1.23 (95% CI, 1.01–1.48), and serotonin selective reuptake inhibitors (SSRI) with a RR = 1.33 (95% CI, 1.20–1.48). Mianserin was effective for continuous outcomes. Numbers needed to treat (NNT) for TCA = 8.5; SSRI = 6.5; and venlafaxine = 6. Most studies were industry-funded and of a brief duration (≤ 8 weeks). There was evidence of publication bias. There were no studies comparing newer antidepressants against placebo.

CONCLUSION: Antidepressants such as TCA, SSRI, SNRI (serotonin–norepinephrine reuptake inhibitor) and NaSSA (noradrenergic and specific serotonergic antidepressant) classes appear to be effective in primary care when compared with placebo. However, in view of the potential for publication bias and that only four studies were not funded by industry, caution is needed when considering their use in primary care.

KEYWORDS: Antidepressant agents; primary health care; placebos; clinical trial; meta-analysis; general practice


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