Tratamiento farmacológico para la depresión psicótica
Appendices
Appendix 1. Updated search strategies (all databases) 2020
Date of search: 21‐Feb‐2020
2013 onwards
Ovid MEDLINE, n=332
Ovid Embase, n=621
Ovid PsycINFO, n=212
CLib: CENTRAL, n=663
International Trial Registers, ℅ CLib:CENTRAL, n=147
CCMDCTR, n=229
Total=2204
Duplicates removed, n=834
To Screen, n=1370
Ovid MEDLINE(R) and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations and Daily <1946 to February 20, 2020>
Search Strategy:
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
1 ((depressed or depression? or depressive?) adj5 (delusion* or psychotic or psychosis or psychoses)).ti,ab,kf. (8220)
2 (*depression/ or depressive disorder/ or depressive disorder, major/) and (psychotic disorders/ or affective disorders, psychotic/ or delusions/) (5242)
3 or/1‐2 (11662)
4 controlled clinical trial.pt. (93531)
5 randomized controlled trial.pt. (500168)
6 clinical trials as topic/ (190121)
7 (randomi#ed or randomi#ation or randomi#ing).ti,ab,kf. (618912)
8 (RCT or "at random" or (random* adj3 (administ* or allocat* or assign* or class* or cluster or crossover or cross‐over or control* or determine* or divide* or division or distribut* or expose* or fashion or number* or place* or pragmatic or quasi or recruit* or split or subsitut* or treat*))).ti,ab,kf. (543410)
9 placebo.ab,ti,kf. (210587)
10 trial.ti. (212770)
11 (control* adj3 group*).ab. (522518)
12 (control* and (trial or study or group*) and (waitlist* or wait* list* or ((treatment or care) adj2 usual))).ti,ab,kf,hw. (24123)
13 ((single or double or triple or treble) adj2 (blind* or mask* or dummy)).ti,ab,kf. (170411)
14 double‐blind method/ or random allocation/ or single‐blind method/ (275150)
15 or/4‐14 (1685135)
16 exp animals/ not humans.sh. (4670680)
17 15 not 16 (1458014)
18 3 and 17 (1185)
19 (2013* or 2014* or 2015* or 2016* or 2017* or 2018* or 2019* or 2020*).yr,dp,dt,ep,ez. (8482040)
20 18 and 19 (332)
***************************
Embase <1974 to 2020 Week 07>
Search Strategy:
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
1 (major depression/ or *depression/) and (psychosis/ or acute psychosis/ or affective psychosis/ or brief psychotic disorder/ or delusion/) (7260)
2 depressive psychosis/ (1263)
3 ((depressed or depression? or depressive?) adj5 (delusion* or psychotic or psychosis or psychoses)).ti,ab,kw. (10743)
4 or/1‐3 (16342)
5 randomized controlled trial/ (589879)
6 randomization.de. (85791)
7 controlled clinical trial/ and drug therapy.fs. (200095)
8 placebo.de. (345862)
9 placebo.ti,ab. (300942)
10 trial.ti. (290976)
11 (randomi#ed or randomi#ation or randomi#ing).ti,ab,kw. (890491)
12 (RCT or "at random" or (random* adj3 (administ* or allocat* or assign* or class* or cluster or control* or crossover or cross‐over or determine* or divide* or division or distribut* or expose* or fashion or number* or place* or pragmatic or quasi or recruit* or split or subsitut* or treat*))).ti,ab,kw. (745781)
13 ((singl$ or doubl$ or trebl$ or tripl$) adj3 (blind$ or mask$ or dummy)).mp. (302956)
14 (control* and (study or group?) and (waitlist* or wait* list* or ((treatment or care) adj2 usual) or no? treatment)).ti,ab,kw,hw. (66667)
15 or/5‐14 (1684443)
16 ((animal or nonhuman) not (human and (animal or nonhuman))).de. (5598527)
17 15 not 16 (1525666)
18 4 and 17 (1796)
19 (2013* or 2014* or 2015* or 2016* or 2017* or 2018* or 2019* or 2020*).yr,dp,dc. (11481480)
20 18 and 19 (663)
21 (schizophrenia not ((delusion* or psychotic or psychosis or psychoses) and depress*)).ti. (80072)
22 20 not 21 (621)
***************************
PsycINFO <1806 to February Week 3 2020>
Search Strategy:
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
1 ((depressed or depression? or depressive?) adj5 (delusion* or psychotic or psychosis or psychoses)).ti,ab,id. (8958)
2 exp major depression/ and (psychosis/ or acute psychosis/ or affective psychosis/ or delusions/) (2118)
3 1 or 2 (9616)
4 clinical trials.sh. (11573)
5 (randomi#ed or randomi#ation or randomi#ing).ti,ab,id. (83956)
6 (RCT or at random or (random* adj3 (administ* or allocat* or assign* or class* or control* or crossover or cross‐over or determine* or divide* or division or distribut* or expose* or fashion or number* or place* or recruit* or split or subsitut* or treat*))).ti,ab,id. (100141)
7 (control* and (trial or study or group) and (placebo or waitlist* or wait* list* or ((treatment or care) adj2 usual))).ti,ab,id,hw. (28575)
8 ((single or double or triple or treble) adj2 (blind* or mask* or dummy)).ti,ab,id. (25894)
9 trial.ti. (29617)
10 placebo.ti,ab,id,hw. (39738)
11 treatment outcome.md. (20165)
12 treatment effectiveness evaluation.sh. (23913)
13 or/4‐12 (190455)
14 3 and 13 (621)
15 (2013* or 2014* or 2015* or 2016* or 2017* or 2018* or 2019* or 2020*).yr,an. (1349880)
16 14 and 15 (212)
***************************
Cochrane Central Register of Controlled Trials (CENTRAL), Issue 2 of 12, 2020
#1 ((depression or “depressive disorder”) and (psychosis or psychotic or delusion*)):kw
#2 "depressive psychosis”:kw
#3 ((depressed or depression* or depressive*) NEAR (delusion* or psychotic or psychosis or psychoses)):ti,ab
#4 (#1 or #2 or #3)
#5 Limit 2013 to date, n=663
Trial Registry Records ℅ CENTRAL
#1 ((depression or “depressive disorder”) and (psychosis or psychotic or delusion*)):ti
#2 "psychotic depression" or (depressi* near/2 (psychosis or psychoses or psychotic))
#3 (#1 or #2)
#4 "clinicaltrials.gov" or “who.int"
#5 (#3 and #4) n=147
***************************
Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) (2013‐2016) [Current to June 2016 only]
#1 ((depressed or depression* or depressive*) AND (delusion* or psychotic or psychosis or psychoses)):TI,EH,EMT,KW,KY,MH
#2 ((depressed or depression* or depressive*) ADJ5 (delusion* or psychotic or psychosis or psychoses)):AB,SO
#3 (#1 OR #2)
#4 ((2013 OR 2014 OR 2015 OR 2016)):XDD AND INREGISTER
#5 (#3 AND #4) n=229
***************************
Appendix 2. Previous search strategies to 2013
The Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) (previously known as the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group's Controlled Trials Register (CCDANCTR)) was searched using the following terms. This register included relevant reports of RCTs collated from routine searches of Ovid MEDLINE (1950‐), EMBASE (1974‐), PsycINFO (1960‐) and the Cochrane Central Register of Controlled Trials (CENTRAL).
The CCMDCTR‐Studies Register was searched (all years to 12 April 2013) using the following terms:
Condition = (depressi* or “affective disorder*” or “affective symptoms”)
AND
Condition or Comorbidity = (psychosis or psychoses or psychotic* or delusion*)
The CCMDCTR‐Studies Register was searched (all years to 12 April 2013) using the following terms to identify additional untagged references:
Title/Abstract/Keywords = ((depressi* or “affective disorder*” or “affective symptoms”)
AND
Free‐Text=(psychosis or psychoses or psychotic* or delusion* or hallucin* or antipsychotic* or psychotropic*))
***************************
In 2010 an additional search of the Cochrane Central Register of Controlled Trials (CENTRAL) was carried out.
The Cochrane Register of Controlled Trails (CENTRAL) was searched (Issue 4, 2010) using the following terms:
#1 MeSH descriptor DEPRESSION, this term only
#2 MeSH descriptor DEPRESSIVE DISORDER, this term only
#3 MeSH descriptor DEPRESSIVE DISORDER MAJOR, this term only
#4 (depression* or depressive*):ti,ab,kw
#5 (#1 or #2 or #3 or #4)
#6 MeSH descriptor DELUSIONS, this term only
#7 delusion*:ti,ab,kw
#8 MeSH descriptor PSYCHOTIC DISORDERS, this term only
#9 MeSH AFFECTIVE DISORDERS, PSYCHOTIC, this term only
#10 (psychotic* or psychosis or psychoses) :ti,ab,kw
#11 (#6 or #7 or #8 or #9 or #10)
#12 (#5 and #11), from 2005 to 2010
#13 SR‐DEPRESSN or HS‐DEPRESSN
#14 (#12 NOT #13)
***************************
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) with the terms depressive disorder and drug treatment. In addition we searched MEDLINE (1966 until April 2004) and EMBASE (1980 until April 2004) using the following terms: (“depressive disorder/drug therapy”[MESH] AND ((“delusions”[MESH Terms] OR delusions[Text Word]) OR ((“psychotic disorders”[MESH Terms] OR psychotic[Text Word]) AND features[All Fields])))) combined with a sensitive search strategy for RCTs.
***************************
Appendix 3. Description of the CCMDCTR
Specialised Register of the Cochrane Common Mental Disorders Group (CCMDCTR)
The Cochrane Common Mental Disorders Group maintains an archived, specialised register of randomised controlled trials, the CCMDCTR. This register contains over 40,000 reference records (reports of RCTs) for anxiety and depressive disorders, bipolar disorder, eating disorders, self‐harm, and other mental disorders within the scope of this Group. The CCMDCTR is a partially studies based register with > 50% of the reference records tagged to c12,600 individually PICO coded study records. Reports of trials for inclusion in the register were collated from (weekly) generic searches of key bibliographic databases to June 2016, which included MEDLINE (1950‐), Embase (1974‐), and PsycINFO (1967‐), quarterly searches of the Cochrane Central Register of Controlled Trials (CENTRAL), and review‐specific searches of additional databases. Reports of trials were also sourced from international trial registries, drug companies, handsearching of key journals, conference proceedings, and other (non‐Cochrane) systematic reviews and meta‐analyses. Details of CCMD's core search strategies (used to identify RCTs) can be found on the Group's website with an example of the core MEDLINE search displayed below.
A weekly search alert based on condition + RCT filter only
1. [MeSH Headings]: eating disorders/ or anorexia nervosa/ or binge‐eating disorder/ or bulimia nervosa/ or female athlete triad syndrome/ or pica/ or hyperphagia/ or bulimia/ or self‐injurious behavior/ or self mutilation/ or suicide/ or suicidal ideation/ or suicide, attempted/ or mood disorders/ or affective disorders, psychotic/ or bipolar disorder/ or cyclothymic disorder/ or depressive disorder/ or depression, postpartum/ or depressive disorder, major/ or depressive disorder, treatment‐resistant/ or dysthymic disorder/ or seasonal affective disorder/ or neurotic disorders/ or depression/ or adjustment disorders/ or exp antidepressive agents/ or anxiety disorders/ or agoraphobia/ or neurocirculatory asthenia/ or obsessive‐compulsive disorder/ or obsessive hoarding/ or panic disorder/ or phobic disorders/ or stress disorders, traumatic/ or combat disorders/ or stress disorders, post‐traumatic/ or stress disorders, traumatic, acute/ or anxiety/ or anxiety, castration/ or koro/ or anxiety, separation/ or panic/ or exp anti‐anxiety agents/ or somatoform disorders/ or body dysmorphic disorders/ or conversion disorder/ or hypochondriasis/ or neurasthenia/ or hysteria/ or munchausen syndrome by proxy/ or munchausen syndrome/ or fatigue syndrome, chronic/ or obsessive behavior/ or compulsive behavior/ or behavior, addictive/ or impulse control disorders/ or firesetting behavior/ or gambling/ or trichotillomania/ or stress, psychological/ or burnout, professional/ or sexual dysfunctions, psychological/ or vaginismus/ or Anhedonia/ or Affective Symptoms/ or *Mental Disorders/
2. [Title/ Author Keywords]: (eating disorder* or anorexia nervosa or bulimi* or binge eat* or (self adj (injur* or mutilat*)) or suicide* or suicidal or parasuicid* or mood disorder* or affective disorder* or bipolar i or bipolar ii or (bipolar and (affective or disorder*)) or mania or manic or cyclothymic* or depression or depressive or dysthymi* or neurotic or neurosis or adjustment disorder* or antidepress* or anxiety disorder* or agoraphobia or obsess* or compulsi* or panic or phobi* or ptsd or posttrauma* or post trauma* or combat or somatoform or somati#ation or medical* unexplained or body dysmorphi* or conversion disorder or hypochondria* or neurastheni* or hysteria or munchausen or chronic fatigue* or gambling or trichotillomania or vaginismus or anhedoni* or affective symptoms or mental disorder* or mental health).ti,kf.
3. [RCT filter]: (controlled clinical trial.pt. or randomized controlled trial.pt. or (randomi#ed or randomi#ation).ab,ti. or randomly.ab. or (random* adj3 (administ* or allocat* or assign* or class* or control* or determine* or divide* or distribut* or expose* or fashion or number* or place* or recruit* or subsitut* or treat*)).ab. or placebo*.ab,ti. or drug therapy.fs. or trial.ab,ti. or groups.ab. or (control* adj3 (trial* or study or studies)).ab,ti. or ((singl* or doubl* or tripl* or trebl*) adj3 (blind* or mask* or dummy*)).mp. or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or randomized controlled trial/ or pragmatic clinical trial/ or (quasi adj (experimental or random*)).ti,ab. or ((waitlist* or wait* list* or treatment as usual or TAU) adj3 (control or group)).ab.)
4. (1 and 2 and 3)
Records were screened for reports of RCTs within the scope of the Cochrane Common Mental Disorders Group. Secondary reports of RCTs were tagged to the appropriate study record.
Similar weekly search alerts were also conducted on OVID Embase and PsycINFO, using relevant subject headings (controlled vocabularies) and search syntax appropriate to each resource. A quarterly search of the Cochrane Central Register of Controlled Trials (CENTRAL) was also conducted.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Study flow diagram.
Comparison 1: Antidepressant versus placebo, Outcome 1: Clinical response
Comparison 1: Antidepressant versus placebo, Outcome 2: Dropouts
Comparison 2: Antipsychotic versus placebo, Outcome 1: Clinical response
Comparison 2: Antipsychotic versus placebo, Outcome 2: Dropouts
Comparison 3: Antidepressant versus antidepressant, Outcome 1: Clinical response
Comparison 3: Antidepressant versus antidepressant, Outcome 2: Dropouts
Comparison 4: Antidepressant versus antipsychotic, Outcome 1: Clinical response
Comparison 4: Antidepressant versus antipsychotic, Outcome 2: Dropouts
Comparison 5: Antidepressant plus antipsychotic versus placebo, Outcome 1: Clinical response
Comparison 5: Antidepressant plus antipsychotic versus placebo, Outcome 2: Dropouts
Comparison 6: Antidepressant plus antipsychotic versus placebo plus antipsychotic, Outcome 1: Clinical response
Comparison 6: Antidepressant plus antipsychotic versus placebo plus antipsychotic, Outcome 2: Dropouts
Comparison 7: Antidepressant plus antipsychotic versus placebo plus antidepressant, Outcome 1: Clinical response
Comparison 7: Antidepressant plus antipsychotic versus placebo plus antidepressant, Outcome 2: Dropouts
Comparison 8: Antidepressant plus antipsychotic versus placebo plus the same antidepressant, Outcome 1: Clinical response
Comparison 8: Antidepressant plus antipsychotic versus placebo plus the same antidepressant, Outcome 2: Dropouts
| Antidepressant compared to placebo for psychotic depression | ||||||
| Patient or population: adults with psychotic depression | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | №. of participants | Certainty of evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with placebo | Risk with antidepressant | |||||
| Clinical response of depression | Study population | RR 8.40 | 27 | ⊕⊝⊝⊝ | Study defined depression response as HRSD‐17 < 7 | |
| 36 per 1000 | 300 per 1000 | |||||
| Overall dropouts | Study population | RR 1.24 | 27 | ⊕⊝⊝⊝ |
| |
| 231 per 1000 | 286 per 1000 | |||||
| Depression remission | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Change in depression severity from baseline | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Quality of life | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Dropouts due to adverse effects | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| aDowngraded one level for high risk of other bias. bDowngraded one level for high risk of publication bias. cDowngraded one level for imprecision due to small sample size; CIs are consistent with appreciable benefit and appreciable harm. | ||||||
| Antipsychotic compared to placebo for psychotic depression | ||||||
| Patient or population: adults with psychotic depression | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | №. of participants | Certainty of evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with placebo | Risk with antipsychotic | |||||
| Clinical response of depression | Study population | RR 1.13 | 201 | ⊕⊝⊝⊝ | Studies defined depression response as reduction in HAMD‐24 ≥ 50% at endpoint | |
| 280 per 1000 | 316 per 1000 | |||||
| Overall dropouts | Study population | RR 0.79 | 201 | ⊕⊝⊝⊝ |
| |
| 470 per 1000 | 371 per 1000 | |||||
| Depression remission | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Change in depression severity from baseline | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Quality of life | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Dropouts due to adverse effects | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| aDowngraded one level for high risk of other bias. bDowngraded one level for high risk of publication bias. cDowngraded one level for imprecision due to small sample size; CIs are consistent with appreciable benefit and appreciable harm. | ||||||
| Antidepressant compared to antidepressant for psychotic depression | ||||||
| Patient or population: adults with psychotic depression | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | №. of participants | Certainty of evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with antidepressant | Risk with antidepressant | |||||
| Clinical response | See comment | ‐ | ‐ | ⊕⊝⊝⊝ | Meta‐analysis was not possible due to heterogeneity between the different antidepressants used van den Broek 2004a showed that imipramine may be more effective than fluvoxamine (RR 2.10, 95% CI 1.06 to 4.17) Bruijn 1996 showed that imipramine may be more effective than mirtazapine (RR 3.00, 95% CI 1.01 to 8.95) Zanardi 1996 showed that sertraline may be more effective than paroxetine (RR 3.37, 95% CI 1.19 to 9.57) Zanardi 2000 found no difference between fluvoxamine and venlafaxine (RR 1.50, 95% CI 0.82 to 2.75) Wijkstra 2010 found no difference between imipramine and venlafaxine (RR 1.57, 95% CI 0.93 to 2.67) | |
| Overall dropouts | See comment | ‐ | ‐ | ⊕⊝⊝⊝ | Wijkstra 2010 found no difference between imipramine and venlafaxine (RR 0.81, 95% CI 0.33 to 2.03) Bruijn 1996 found no difference between imipramine and mirtazapine (RR 0.50, 95% CI 0.19 to 1.31) van den Broek 2004a found no difference between imipramine and fluvoxamine (RR 2.00, 95% CI 0.40 to 9.95) Zanardi 1996 found no difference between sertraline and paroxetine (RR 0.20, 95% CI 0.01 to 3.74) Zanardi 2000 found no difference between fluvoxamine and venlafaxine (RR 0.07, 95% CI 0.00 to 1.20) | |
| Depression remission | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Change in depression severity from baseline | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Quality of life | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Dropouts due to adverse effects | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| aDowngraded one level for imprecision due to small sample size. bDowngraded one level for imprecision as CIs are consistent with appreciable benefit and appreciable harm. cDowngraded one level for high risk of publication bias. | ||||||
| Antidepressant compared to antipsychotic for psychotic depression | ||||||
| Patient or population: adults with psychotic depression | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | №. of participants | Certainty of evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with antipsychotic | Risk with antidepressant | |||||
| Clinical response of depression | Study population | RR 2.09 | 36 | ⊕⊝⊝⊝ | Study defined depression response as HRSD‐17 < 7 | |
| 176 per 1000 | 369 per 1000 | |||||
| Overall dropouts | Study population | RR 1.79 | 36 | ⊕⊝⊝⊝ |
| |
| 59 per 1000 | 105 per 1000 | |||||
| Depression remission | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Change in depression severity from baseline | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Quality of life | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Dropouts due to adverse effects | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| aDowngraded one level for imprecision due to small sample size. bDowngraded one level for imprecision as CIs are consistent with appreciable benefit and appreciable harm. cDowngraded one level for risk of publication bias. | ||||||
| Antidepressant plus antipsychotic compared to placebo for psychotic depression | ||||||
| Patient or population: adults with psychotic depression | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | №. of participants | Certainty of evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with placebo | Risk with antidepressant plus antipsychotic | |||||
| Clinical response of depression | Study population | RR 1.86 | 148 | ⊕⊝⊝⊝ | Both studies defined response as reduction in HAMD‐24 ≥ 50% at endpoint | |
| 280 per 1000 | 521 per 1000 | |||||
| Overall dropouts | Study population | RR 0.75 | 148 | ⊕⊝⊝⊝ |
| |
| 470 per 1000 | 353 per 1000 | |||||
| Depression remission | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Change in depression severity from baseline | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Quality of life | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Dropouts due to adverse effects | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| aDowngraded one level for for high risk of other source of bias. bDowngraded one level for for high risk of publication bias. cDowngraded one level for imprecision due to small sample size. dDowngraded one level for imprecision due to small sample size; CIs are consistent with appreciable benefit and appreciable harm. | ||||||
| Antidepressant plus antipsychotic compared to placebo plus antipsychotic for psychotic depression | ||||||
| Patient or population: adults with psychotic depression | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | №. of participants | Certainty of evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with placebo plus antipsychotic | Risk with antidepressant plus antipsychotic | |||||
| Clinical response of depression | Study population | RR 1.83 | 447 | ⊕⊕⊝⊝ | 2 studies defined response as reduction in HAMD‐24 ≥ 50% at endpoint, 1 study defined response as HAMD‐17 ≦ 10, and another study defined response as HRSD‐17 < 7 | |
| 266 per 1000 | 487 per 1000 | |||||
| Overall dropouts | Study population | RR 0.79 | 447 | ⊕⊕⊝⊝ |
| |
| 435 per 1000 | 344 per 1000 | |||||
| Depression remission | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Change in depression severity from baseline | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Quality of life | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Dropouts due to adverse effects | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| aDowngraded one level for high risk of other source of bias. bDowngraded one level for high risk of publication bias. cDowngraded one level for imprecision as CIs are consistent with appreciable benefit and appreciable harm. | ||||||
| Antidepressant plus antipsychotic compared to placebo plus antidepressant for psychotic depression | ||||||
| Patient or population: adults with psychotic depression | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | №. of participants | Certainty of evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with placebo plus antidepressant | Risk with antidepressant plus antipsychotic | |||||
| Clinical response of depression | Study population | RR 1.42 | 245 | ⊕⊕⊝⊝ | One study defined response as HRSD‐17 < 7, another study defined response as HAMD‐17 ≦ 10, another study defined response as HAMD‐17 < 11, and a fourth study defined response as reduction in HRSD‐17 > 50% | |
| 436 per 1000 | 619 per 1000 | |||||
| Overall dropouts | Study population | RR 0.91 | 245 | ⊕⊝⊝⊝ |
| |
| 207 per 1,000 | 189 per 1,000 | |||||
| Depression remission | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Change in depression severity from baseline | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Quality of life | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Dropouts due to adverse effects | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| aDowngraded for high risk of attrition bias and other source of bias in one study. bDowngraded one level for high risk of publication bias. cDowngraded one level for imprecision due to small sample size. dDowngraded one level for imprecision due to small sample size; CIs are consistent with appreciable benefit and appreciable harm. | ||||||
| Antidepressant plus antipsychotic compared to placebo plus the same antidepressant for psychotic depression | ||||||
| Patient or population: adults with psychotic depression | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | №. of participants | Certainty of evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with placebo plus the same antidepressant | Risk with antidepressant plus antipsychotic | |||||
| Clinical response of depression | Study population | RR 1.70 | 157 | ⊕⊕⊝⊝ | One study defined response as HAMD‐17 < 11, another study defined response as HRSD‐17 < 7, and a third study defined response as ≧ 50% decrease in HAMD‐17 scores from baseline to study endpoint | |
| 351 per 1000 | 596 per 1000 | |||||
| Overall dropouts | Study population | RR 1.04 | 157 | ⊕⊝⊝⊝ |
| |
| 169 per 1000 | 176 per 1000 | |||||
| Depression remission | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Change in depression severity from baseline | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Quality of life | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| Dropouts due to adverse effects | See comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| aDowngraded one level for high risk of other source of bias. bDowngraded one level for high risk of publication bias. cDowngraded one level for imprecision due to small sample size. dDowngraded one level for imprecision due to small sample size; CIs are consistent with appreciable harm and appreciable benefit. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Clinical response Show forest plot | 1 | 27 | Risk Ratio (M‐H, Fixed, 95% CI) | 8.40 [0.50, 142.27] |
| 1.2 Dropouts Show forest plot | 1 | 27 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.24 [0.34, 4.51] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Clinical response Show forest plot | 2 | 201 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.13 [0.74, 1.73] |
| 2.2 Dropouts Show forest plot | 2 | 201 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.57, 1.08] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Clinical response Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.1.1 Imipramine vs venlafaxine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.1.2 Imipramine vs mirtazapine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.1.3 Imipramine vs fluvoxamine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.1.4 Fluvoxamine vs venlafaxine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.1.5 Sertraline vs paroxetine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.2 Dropouts Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.2.1 Imipramine vs venlafaxine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.2.2 Imipramine vs mirtazapine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.2.3 Imipramine vs fluvoxamine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.2.4 Fluvoxamine vs venlafaxine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.2.5 Sertraline vs paroxetine | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Clinical response Show forest plot | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.09 [0.64, 6.82] |
| 4.2 Dropouts Show forest plot | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.79 [0.18, 18.02] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Clinical response Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 5.1.1 Fluoxetine + olanzapine vs placebo | 2 | 148 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.86 [1.23, 2.82] |
| 5.2 Dropouts Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 5.2.1 Fluoxetine + olanzapine vs placebo | 2 | 148 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.48, 1.18] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Clinical response Show forest plot | 4 | 447 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.83 [1.40, 2.38] |
| 6.1.1 Amitriptyline + perphenazine vs perphenazine | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.61 [1.23, 10.56] |
| 6.1.2 Fluoxetine + olanzapine vs olanzapine | 2 | 149 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.64 [1.10, 2.44] |
| 6.1.3 Olanzapine + sertraline vs olanzapine | 1 | 259 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.76 [1.21, 2.54] |
| 6.2 Dropouts Show forest plot | 4 | 447 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.63, 1.01] |
| 6.2.1 Amitriptyline + perphenazine vs perphenazine | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.09 [0.38, 25.19] |
| 6.2.2 Fluoxetine + olanzapine vs olanzapine | 2 | 149 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.59, 1.53] |
| 6.2.3 Olanzapine + sertraline vs olanzapine | 1 | 259 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.53, 0.92] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Clinical response Show forest plot | 4 | 245 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.42 [1.11, 1.80] |
| 7.1.1 Nortriptyline + perphenazine vs nortriptyline | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.12 [0.49, 2.53] |
| 7.1.2 Venlafaxine + quetiapine vs venlafaxine | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.95 [1.13, 3.37] |
| 7.1.3 Amitriptyline + perphenazine vs amitriptyline | 1 | 41 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.73 [0.89, 3.37] |
| 7.1.4 Amitriptyline + perphenazine vs amoxapine | 1 | 46 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.19 [0.75, 1.88] |
| 7.1.5 Venlafaxine + quetiapine vs imipramine | 1 | 63 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.27 [0.84, 1.93] |
| 7.2 Dropouts Show forest plot | 4 | 245 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.91 [0.55, 1.50] |
| 7.2.1 Nortriptyline + perphenazine vs nortriptyline | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.12 [0.26, 4.81] |
| 7.2.2 Venlafaxine + quetiapine vs venlafaxine | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.22, 2.46] |
| 7.2.3 Amitriptyline + perphenazine vs amitriptyline | 1 | 41 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.73 [0.35, 8.41] |
| 7.2.4 Amitriptyline + perphenazine vs amoxapine | 1 | 46 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.29, 1.45] |
| 7.2.5 Venlafaxine + quetiapine vs imipramine | 1 | 63 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.14 [0.38, 3.47] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 8.1 Clinical response Show forest plot | 3 | 157 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.70 [1.19, 2.43] |
| 8.2 Dropouts Show forest plot | 3 | 157 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.04 [0.52, 2.07] |
| 8.2.1 Nortriptyline + perphenazine vs nortriptyline | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.12 [0.26, 4.81] |
| 8.2.2 Venlafaxine + quetiapine vs venlafaxine | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.33, 2.08] |
| 8.2.3 Amitriptyline + perphenazine vs amitriptyline | 1 | 41 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.73 [0.35, 8.41] |
