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Efficacy of Antidepressants for Depression in Alzheimer's Disease: Systematic Review and Meta-Analysis

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 , 58 (3) pp. 725-733. 10.3233/JAD-161247. Green open access

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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.

Type: Article
Title: Efficacy of Antidepressants for Depression in Alzheimer's Disease: Systematic Review and Meta-Analysis
Location: Netherlands
Open access status: An open access version is available from UCL Discovery
DOI: 10.3233/JAD-161247
Publisher version: http://dx.doi.org/10.3233/JAD-161247
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Alzheimer’s disease, Antidepressants, depression, effectiveness, meta-analysis, randomized controlled trials
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/1557103
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