TY - JOUR
T1 - Hybrid Systematic Review and Network Meta-Analysis of Randomized Controlled Trials of Interventions for Depressive Symptoms in Patients with Coronary Artery Disease
AU - Doyle, Frank
AU - Freedland, Kenneth E.
AU - Carney, Robert M.
AU - De Jonge, Peter
AU - Dickens, Chris
AU - Pedersen, Susanne S.
AU - Sorensen, Jan
AU - Dempster, Martin
N1 - Publisher Copyright:
© Lippincott Williams and Wilkins.
PY - 2021
Y1 - 2021
N2 - Objective Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-Analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy. Methods We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8 week after treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random-effects network meta-Analysis was used to synthesize the evidence, and evidence quality was evaluated following Grading of Recommendations, Assessment, Development and Evaluations recommendations. Results Thirty-Three RCTs (7240 participants) provided analyzable data. All treatments were equally acceptable. At 8 weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26 weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. Grading of Recommendations, Assessment, Development and Evaluations ratings ranged from very low to low. Conclusions Overall, the evidence was limited and biased. Although all treatments for post-CAD depression were equally acceptable, antidepressants have the most robust evidence base and should be the first-line treatment. Combinations of antidepressants and psychotherapy, along with exercise, could be more effective than antidepressants alone but require further rigorous, multiarm intervention trials.
AB - Objective Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-Analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy. Methods We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8 week after treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random-effects network meta-Analysis was used to synthesize the evidence, and evidence quality was evaluated following Grading of Recommendations, Assessment, Development and Evaluations recommendations. Results Thirty-Three RCTs (7240 participants) provided analyzable data. All treatments were equally acceptable. At 8 weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26 weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. Grading of Recommendations, Assessment, Development and Evaluations ratings ranged from very low to low. Conclusions Overall, the evidence was limited and biased. Although all treatments for post-CAD depression were equally acceptable, antidepressants have the most robust evidence base and should be the first-line treatment. Combinations of antidepressants and psychotherapy, along with exercise, could be more effective than antidepressants alone but require further rigorous, multiarm intervention trials.
KW - CAD = coronary artery disease
KW - GRADE = Grading of Recommendations, Assessment, Development and Evaluations
KW - NMA = network meta-Analysis
KW - OR = odds ratio
KW - RCTs = randomized controlled trials
KW - RoB = risk of bias
KW - SMD = standardized mean difference
KW - coronary artery disease
KW - depression
KW - intervention
KW - network meta-Analysis
KW - randomized controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85107412216&partnerID=8YFLogxK
U2 - 10.1097/PSY.0000000000000944
DO - 10.1097/PSY.0000000000000944
M3 - Review article
C2 - 34074982
AN - SCOPUS:85107412216
SN - 0033-3174
VL - 83
SP - 423
EP - 431
JO - Psychosomatic Medicine
JF - Psychosomatic Medicine
IS - 5
ER -