A systematic review of the treatment of depression with antidepressant drugs in patients who also have a physical illness

determine whether antidepressants are clinically effective and acceptable f or the treatment of depression in people who also have a physical illness. The method used was a systematic review of all randomised controlled trials (found by computer and hand searches) comparing any antidepressant drug wi th placebo or no treatment, in depressed adults with a specified,physical d isorder. The main outcome measures are numbers of individuals who recover/i mprove at the end of the trial and, as a proxy for treatment acceptability, numbers who complete treatment. 18 studies were included, covering 838 pa patients with a range of physical diseases. 6 studies used SSRIs, 3 atypica l antidepressants, and the remainder tricyclics. Patients treated with anti depressants were significantly more likely to improve than those given plac ebo: about 4 patients would need to be treated with antidepressants to prod uce one recovery from depression which would not have occurred had they bee n given placebo (NNT 4.2, 95% CI 3.2-6.4). Most antidepressants (tricyclics and SSRIs together, 15 trials) produced a small but significant increase i n dropout (OR 1.66, 95% CI 1.14-2.40. NNH 9.8, 95% CI 5.4-42.9). The "atypi cal" antidepressant mianserin produced significantly less dropout than plac ebo. Trends towards tricyclics being more effective than SSRIs, but also mo re likely to produce dropout were noted. The review provides evidence that antidepressants, significantly more frequently than either placebo or no tr eatment, cause improvement in depression in patients with a wide range of p hysical diseases. (C) 1999 Elsevier Science Inc.