[Systematic review to evaluate the efficacy, acceptability and safety of second-generation antipsychotics for the treatment of unipolar and bipolar depression.]

Amato, Laura; Vecchi, Simona; Barbui, Corrado; Cruciani, Fabio; D'Amico, Roberto; Del Giovane, Cinzia; Minozzi, Silvia; Mitrova, Zuzana; Saulle, Rosella; Davoli, Marina (2018). [Systematic review to evaluate the efficacy, acceptability and safety of second-generation antipsychotics for the treatment of unipolar and bipolar depression.]. Recenti progressi in medicina, 109(10), pp. 474-486. Pensiero Scientifico 10.1701/3010.30085

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BACKGROUND The World Health Organization (WHO) estimates that depression affects about 121 million people in the world and in terms of years of illness, by the year 2020 could become the second most prevalent disease in the world population after cardiovascular diseases. Second-generation antipsychotics (SGAs) seems to induce remission in depression when added to an antidepressant. AIM To evaluate the efficacy and safety of SGAs for the treatment of depression. METHODS We searched five bibliographic databases. We assessed the quality of evidence using Cochrane and GRADE criteria. RESULTS We included 42 RCTs. Where possible, we made a statistical synthesis of results. For efficacy outcomes, in direct comparisons in unipolar and bipolar patients with acute depressive episode, and in unipolar patients who did not respond to previous treatments with antidepressants (non-responders), SGAs gave better results than placebo, moderate to low certainty of evidence. In the comparison with antidepressants, in unipolar and bipolar patients with acute depressive episode the evidence was in favour of SGAs high certainty of evidence; while in the non-responder unipolar patients (the included studies considered only this typology of patients) the evidence was in favour of the antidepressants, low certainty of evidence. For safety outcomes, the results were in favour of placebo for patients with at least one adverse event, and in favour of SGAs for the number of patients with serious adverse events, for both comparisons the certainty of evidence was moderate. Comparing the SGAs with antidepressants, no differences were observed for patients with at least one adverse event, high certainty of evidence; while serious adverse events were less acute in patients treated with SGAs, moderate certainty evidence. The results of direct and indirect comparisons made with the network meta-analysis showed no differences for most of the outcomes considered, not showing a clear superiority of a drug compared to the others. CONCLUSIONS These results showed a moderate effect in favour of SGAs compared to antidepressants in patients, unipolar and bipolar, with a new acute depressive episode and confirm that in patients non-responders, antidepressants may remain more effective.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Del Giovane, Cinzia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0034-1193

Publisher:

Pensiero Scientifico

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

28 Nov 2018 08:36

Last Modified:

28 May 2019 14:50

Publisher DOI:

10.1701/3010.30085

PubMed ID:

30394408

BORIS DOI:

10.7892/boris.121786

URI:

https://boris.unibe.ch/id/eprint/121786

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