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Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis

  • Corrado Barbui (a1), Andrea Cipriani (a1), Vikram Patel (a2), José L. Ayuso-Mateos (a3) and Mark van Ommeren (a4)...
Abstract
Background

Depression is a common condition that has been frequently treated with psychotropics.

Aims

To review systematically the evidence of efficacy and acceptability of antidepressant and benzodiazepine treatments for patients with minor depression.

Method

A systematic review and meta-analysis of double-blind randomised controlled trials comparing antidepressants or benzodiazepines v. placebo in adults with minor depression. Data were obtained from MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Controlled Trials Register and pharmaceutical company websites. Risk of bias was assessed for the generation of the allocation sequence, allocation concealment, masking, incomplete outcome data, and sponsorship bias.

Results

Six studies met inclusion criteria. Three studies compared paroxetine with placebo; fluoxetine, amitriptyline and isocarboxazid were studied in one study each. No studies compared benzodiazepines with placebo. In terms of failures to respond to treatment (6 studies, 234 patients treated with antidepressants and 234 with placebo) no significant difference between antidepressants and placebo was found (relative risk (RR) 0.94, 95% CI 0.81–1.08). In terms of acceptability, data extracted from two studies (93 patients treated with antidepressants and 93 with placebo) showed no statistically significant difference between antidepressants and placebo (RR = 1.06, 95% CI 0.65–1.73). There was no statistically significant between-study heterogeneity for any of the reported analyses.

Conclusions

There is evidence showing there is unlikely to be a clinically important advantage for antidepressants over placebo in individuals with minor depression. For benzodiazepines, no evidence is available, and thus it is not possible to determine their potential therapeutic role in this condition.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial licence (http://creativecommons.org/licenses/by-nc/4.0/), which permits noncommercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Corresponding author
Dr Corrado Barbui, Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico GB Rossi, 37134 Verona, Italy. Email: corrado.barbui@univr.it
Footnotes
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This systematic review was financially supported by the Department of Mental Health and Substance Abuse, World Health Organization (WHO), Geneva, Switzerland. The views expressed in this article are those of the authors solely and do not necessarily represent the views, policies and decisions of WHO. C.B. and A.C. are grateful to the Fondazione Cariverona, who provided a three-year grant to the WHO Collaborating Centre for Research and Training in Mental Health and Service Organization at the University of Verona, directed by Professor Michele Tansella. V.P. is supported by a Wellcome Trust Senior Research Fellowship.

Declaration of interest

J.L.A-M. received consultancy fees from Lundbeck and Risk Management Resources LLC and provided expert testimony for Sanofi-aventis.

Footnotes
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Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis

  • Corrado Barbui (a1), Andrea Cipriani (a1), Vikram Patel (a2), José L. Ayuso-Mateos (a3) and Mark van Ommeren (a4)...
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