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Meta-Analysis
. 2020 Mar 4;20(1):102.
doi: 10.1186/s12888-020-02514-2.

How well do elderly patients with major depressive disorder respond to antidepressants: a systematic review and single-group meta-analysis

Katharina Gutsmiedl  1 , Marc Krause  2 , Irene Bighelli  2 , Johannes Schneider-Thoma  2 , Stefan Leucht  2
Affiliations
Meta-Analysis

How well do elderly patients with major depressive disorder respond to antidepressants: a systematic review and single-group meta-analysis

Katharina Gutsmiedl et al. BMC Psychiatry. .

Abstract

Background: Depression is one of the leading causes of the global burden of disease, and it has particularly negative consequences for elderly patients. Antidepressants are the most frequently used treatment. We present the first single-group meta-analysis examining: 1) the response rates of elderly patients to antidepressants, and 2) the determinants of antidepressants response in this population.

Methods: We searched multiple databases for randomized controlled trials on antidepressants in the elderly with major depressive disorder above 65 years (last search: December 2017). Response was defined as 50% improvement on validated rating scales. We extracted response rates from studies and imputed the missing ones with a validated method. Data were pooled in a single-group meta-analysis. Additionally, several potential moderators of response to antidepressants were examined by subgroup and meta-regression analyses.

Results: We included 44 studies with a total of 6373 participants receiving antidepressants. On average, 50.7% of the patients reached a reduction of at least 50% on the Hamilton Depression Scale (HAMD). Subgroup and meta-regression analyses revealed a better response to treatment for patients in antidepressant-controlled trials compared to placebo-controlled trials. Mean age, study duration, percentage of woman, severity of illness at baseline, dose of antidepressants in fluoxetine equivalents, year of publication, setting (in- or out-patients), antidepressant groups (SSRI, TCA, SSNRI, α2-antagonist, SNRI, MAO-inhibitor), ITT (intention-to-treat) analysis vs completer analysis, sponsorship and overall risk of bias were not significant moderators of response.

Conclusions: Our findings suggest an improvement in symptoms can be found in about 50% of the elderly with major depressive disorder treated with antidepressants.

Keywords: Depression; Elderly; Response; Systematic review.

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Conflict of interest statement

SL has received honoraria for consulting from LB Pharma International B.V., H. Lundbeck A/S, Otsuka Pharmaceutical Co., Ltd., Teva Pharmaceutical Industries Limited, Chemical Works of Gedeon Richter Plc., Recordati S.p.A., LTS Lohmann Therapie-Systeme AG, Boehringer Ingelheim International GmbH; and for lectures from Janssen Global Services, LLC, Eli Lilly and Company, H. Lundbeck A/S, Otsuka Pharmaceutical Co., Ltd.Sanofi-aventis Groupe and Les Laboratoires Servier. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study selection process PRISMA flow-chart
Fig. 2
Fig. 2
Pooled results for response rate of 50% reduction from baseline, random-effects model. The squares represent the response rates and the horizontal lines reflect the 95% confidence interval. The red diamond corresponds to the overall response rate. Cl = Confidence interval
Fig. 3
Fig. 3
Forest Plot - Response rates grouped by antidepressant subgroup. The squares represent the response rates and the horizontal lines reflect the 95% confidence interval. The red diamond corresponds to the subtotal response rate in the different antidepressant groups. MAO-inhibitors = Monoamine oxidase inhibitors, SNRI = Serotonin–norepinephrine reuptake inhibitor, SSNRI = Selective serotonin–norepinephrine reuptake inhibitor, SSRI = Selective serotonin reuptake inhibitor, TCA = Tricyclic antidepressant, CI = Confidence interval
See this image and copyright information in PMC

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