Institute of Medical Biometry and Statistics (IMBI)

Sponsorship: BMBF, Förderkennzeichen 01KG1012

Duration: Start: 01.11.2010

Question of research

Treatment of depressive disorder in primary care - a systematic multi-treatment review of randomized trials of available treatment

Short description

While the vast majority of patients with depression are dealt with in primary care, most of the research findings upon which decisions are made have involved secondary care patients. We aim to systematically review and compare the available evidence for the effectiveness of pharmacological, psychological and combined treatments of patients with depressive disorders in primary care patients. We will search existing systematic reviews and electronic databases to identify randomized controlled trials comparing the effectiveness and safety of pharmacological (e.g., selective serotonine reuptake inhibitors, tricyclic antidepressants, hypericum extracts), psychological or combined interventions with another active therapy, placebo or sham interventions, routine care, or no treatment in patients with depressive disorders recruited in primary care. Study characteristics and findings will be extracted by at least two reviewers. Risk of bias will be assessed using the tool recommended by the Cochrane Collaboration. Meta-analyses (random effects model, inverse variance weighting) will be performed for direct comparisons of single interventions and for groups of similar interventions (for example, SSRIs vs.tricyclics, SSRI vs. hypericum extracts etc.) and defined time-windows (up to 3 months and above). In a secondary global analysis the relative effectiveness of treatments will be estimated from all available direct and indirect evidence that is present in a network of treatments and comparisons, thus suggesting a ranking of interventions according to their relative effectiveness.

Summary of the results

We reviewed 100 randomized trials investigating pharmacological and psychological treatments for primary care patients with depression and carried out a network meta-analysis using response to treatment as primary outcome measure. There were important clinical and statistically significant differences between ‘‘pure’’ drug trials comparing pharmacological substances with each other or placebo (63 trials) and trials including a psychological treatment arm (37 trials). Overall network meta-analysis produced results well comparable with separate meta-analyses of drug trials and psychological trials. Althoughthe transitivity assumption seemed unjustifiable, we observed no major deviation from statistical homogeneity and consistency assumptions.

Publications

www.imbi.uni-freiburg.de/bibl/biblio.pl