Antidepressants are effective against depression in patients suffering from physical illnesses, according to a new systematic review by Cochrane researchers.
The researchers found the drugs were more effective than placebos at treating depression in these patients.
One of the most neglected areas of health care research is the effects of physical illness on an individual's mental health. Research suggests more than 10 percent of patients suffering from physical diseases also suffer from depression. For reasons that are not entirely clear, depression may amplify the symptoms of physical disease and increase the risk of death. Studies suggest doctors are less likely to prescribe antidepressants to people who are physically ill because they are unsure if the medication can help these patients. Therefore, knowing whether antidepressants can be effective in people with physical illness is important.
The review included 51 studies comparing antidepressants to placebos. Most studies looked at selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants. A total of 3,603 patients were involved who suffered from such physical illnesses as stroke, HIV or AIDS, Parkinson's disease and cancer.
The researchers found antidepressants were more effective than placebos, although patients receiving antidepressants were more likely to experience adverse effects, including sexual dysfunction and dry mouth. For every six people receiving treatment, one more could be expected to benefit at between six and eight weeks if they were taking antidepressants.
Said lead author Lauren Rayner, of King's College London, "Although trials were small, they do seem to indicate a genuine benefit associated with antidepressants. However, patients with more severe physical illness and more severely depressed patients were not included in the trials. It is possible that those [patients] with more severe illness don't respond so well to treatment with antidepressants. This is something that should be addressed in further studies."
Senior investigator Professor Matthew Hotopf, of the Institute of Psychiatry at King's College London, added, "As a clinician, I see many patients struggling with the effects of physical disease on their mental health. Doctors should take into account patients' preferences, symptoms and possible interactions with any other medications they are taking when prescribing antidepressants to physically ill patients". He concludes, "This is a critical area of research [that] will help doctors maximise a patient's treatment and recovery from the mental and physical symptoms of illness."
"This research is very important for millions of patients and families who are experiencing physical illness, including the most advanced stages of disease," said Professor Irene Higginson, senior investigator and head of the Cicely Saunders Institute at King's College London. "Until now, many doctors and nurses were worried that these treatments did not work well in people with physical illness. This result shows that they are usually of benefit. Already we are using the results to inform a new European Guideline for doctors and nurses on the management of depression."