Background Despite the high prevalence of depression in people with neurological disorders, no previous study has sought to summarise existing evidence on the use of antidepressants in this population. A systematic review and meta-analysis was undertaken to determine whether antidepressants are more effective than placebo in the treatment of depression in neurological disorders, and whether any benefit is associated with improvement in function.
Methods Embase, Pubmed, Psycinfo and Cochrane trial registers were searched for randomised controlled trials (RCTs) comparing the efficacy of antidepressant and placebo in the treatment of depression in adults with a neurological disorder.
Findings 20 RCTs were included in the review, including patients with Parkinson's disease, multiple sclerosis, brain injury, epilepsy and stroke. Outcomes were analysed at four time points: 4–5 weeks, 6–8 weeks, 9–18 weeks and >18 weeks. The primary outcome was response to treatment at 6–8 weeks. The evidence favoured the use of antidepressants over placebo at all time points although pooled results were not statistically significant at all time points. At 6–8 weeks, antidepressant treatment was associated with a greater than twofold odds of remission (OR 2.23; 95% CI 1.54 to 3.23; number needed to treat=7). Fewer data were available for quality of life, and functional and cognitive outcomes, and there was little evidence of improvement with antidepressant treatment.
Interpretation Antidepressants are effective for the treatment of depression in patients with neurological disorders but the evidence for the efficacy of antidepressants in improving quality of life, and functional and cognitive outcomes is inconclusive.
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Funding This work was performed on behalf of the European Palliative Care Research Collaborative. The European Palliative Care Research Collaborative is funded by the European Commission's Sixth Framework Programme (contract No LSHC-CT-2006-037777, EPCRC) with the overall aim to improve treatment of pain, depression and fatigue through translation research. Core scientific group/work package leaders: Stein Kaasa (project coordinator), Frank Skorpen, Marianne Jensen Hjermstad, Jon Håvard Loge, Norwegian University of Science and Technology (NTNU); Geoffrey Hanks, University of Bristol; Augusto Caraceni, Franco De Conno, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan; Irene Higginson, King's College London; Florian Strasser, Cantonal Hospital St Gallen; Lukas Radbruch, RWTH Aachen University; Kenneth Fearon, University of Edinburgh; Hellmut Samonigg, Medical University of Graz; Ketil Bø, Trollhetta AS, Norway; Irene Rech-Weichselbraun, Bender MedSystems GmbH, Austria; Odd Erik Gundersen, Verdande Technology AS, Norway. Scientific advisory group: Neil Aaronson, The Netherlands Cancer Institute; Vickie Baracos, Robin Fainsinger, University of Alberta; Patrick C Stone, St George's University of London; Mari Lloyd Williams, University of Liverpool. Project management: Stein Kaasa, Ola Dale, Dagny F Haugen, NTNU. The funding body had no role in the study design, analysis and interpretation of data or writing of the review. AE and LR are supported by the European Commission's Sixth Framework Programme. MH is funded by the NIHR Biomedical Research Centre for Mental Health, The South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, King's College London. AP is part funded by St Christopher's Hospice, Sydenham, UK.
Competing interests MH has acted as an expert witness instructed by the claimants in a litigation on the propensity of paroxetine to cause discontinuation symptoms.
Provenance and peer review Not commissioned; externally peer reviewed.