Pharmacological treatment for psychotic depression

Jacolien Kruizinga; Edith Liemburg; Huibert Burger; Andrea Cipriani; John Geddes; Lindsay Robertson; Beatrix Vogelaar; Willem A Nolen

doi:10.1002/14651858.CD004044.pub5

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1: Antidepressant versus placebo, Outcome 1: Clinical response

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1: Antidepressant versus placebo, Outcome 2: Dropouts

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2: Antipsychotic versus placebo, Outcome 1: Clinical response

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2: Antipsychotic versus placebo, Outcome 2: Dropouts

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3: Antidepressant versus antidepressant, Outcome 1: Clinical response

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3: Antidepressant versus antidepressant, Outcome 2: Dropouts

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

Comparison 4: Antidepressant versus antipsychotic, Outcome 1: Clinical response

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.2

Comparison 4: Antidepressant versus antipsychotic, Outcome 2: Dropouts

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.1

Comparison 5: Antidepressant plus antipsychotic versus placebo, Outcome 1: Clinical response

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.2

Comparison 5: Antidepressant plus antipsychotic versus placebo, Outcome 2: Dropouts

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.1

Comparison 6: Antidepressant plus antipsychotic versus placebo plus antipsychotic, Outcome 1: Clinical response

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.2

Comparison 6: Antidepressant plus antipsychotic versus placebo plus antipsychotic, Outcome 2: Dropouts

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 7.1

Comparison 7: Antidepressant plus antipsychotic versus placebo plus antidepressant, Outcome 1: Clinical response

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 7.2

Comparison 7: Antidepressant plus antipsychotic versus placebo plus antidepressant, Outcome 2: Dropouts

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.1

Comparison 8: Antidepressant plus antipsychotic versus placebo plus the same antidepressant, Outcome 1: Clinical response

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.2

Comparison 8: Antidepressant plus antipsychotic versus placebo plus the same antidepressant, Outcome 2: Dropouts

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings 1. Antidepressant compared to placebo for psychotic depression

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Antidepressant compared to placebo for psychotic depression
Patient or population: adults with psychotic depression Setting: hospital Intervention: antidepressant Comparison: placebo
Outcomes	Risk with placebo	Risk with antidepressant	Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Clinical response of depression	Study population		RR 8.40 (0.50 to 142.27)	27 (1 RCT)	⊕⊝⊝⊝ Very low^a,b,c	Study defined depression response as HRSD‐17 < 7
Clinical response of depression	36 per 1000	300 per 1000 (18 to 1000)	RR 8.40 (0.50 to 142.27)	27 (1 RCT)	⊕⊝⊝⊝ Very low^a,b,c	Study defined depression response as HRSD‐17 < 7
Overall dropouts	Study population		RR 1.24 (0.34 to 4.51)	27 (1 RCT)	⊕⊝⊝⊝ Very low^a,b,c
Overall dropouts	231 per 1000	286 per 1000 (78 to 1000)	RR 1.24 (0.34 to 4.51)	27 (1 RCT)	⊕⊝⊝⊝ Very low^a,b,c
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). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^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.

Summary of findings 1. Antidepressant compared to placebo for psychotic depression

Ir a la tabla de la revisión

Summary of findings 2. Antipsychotic compared to placebo for psychotic depression

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Antipsychotic compared to placebo for psychotic depression
Patient or population: adults with psychotic depression Setting: at least first week of study in hospital Intervention: antipsychotic Comparison: placebo
Outcomes	Risk with placebo	Risk with antipsychotic	Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Clinical response of depression	Study population		RR 1.13 (0.74 to 1.73)	201 (2 RCTs)	⊕⊝⊝⊝ Very low^a,b,c	Studies defined depression response as reduction in HAMD‐24 ≥ 50% at endpoint
Clinical response of depression	280 per 1000	316 per 1000 (207 to 484)	RR 1.13 (0.74 to 1.73)	201 (2 RCTs)	⊕⊝⊝⊝ Very low^a,b,c
Overall dropouts	Study population		RR 0.79 (0.57 to 1.08)	201 (2 RCTs)	⊕⊝⊝⊝ Very low^a,b,c
Overall dropouts	470 per 1000	371 per 1000 (268 to 508)	RR 0.79 (0.57 to 1.08)	201 (2 RCTs)	⊕⊝⊝⊝ Very low^a,b,c
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). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^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.

Summary of findings 2. Antipsychotic compared to placebo for psychotic depression

Ir a la tabla de la revisión

Summary of findings 3. Antidepressant compared to antidepressant for psychotic depression

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Antidepressant compared to antidepressant for psychotic depression
Patient or population: adults with psychotic depression Setting: hospital Intervention: antidepressant Comparison: antidepressant
Outcomes	Risk with antidepressant	Risk with antidepressant	Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Clinical response	See comment		‐	‐	⊕⊝⊝⊝ Very low^a,b,c	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		‐	‐	⊕⊝⊝⊝ Very low^a,b,c	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). CI: confidence interval; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^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.

Summary of findings 3. Antidepressant compared to antidepressant for psychotic depression

Ir a la tabla de la revisión

Summary of findings 4. Antidepressant compared to antipsychotic for psychotic depression

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Antidepressant compared to antipsychotic for psychotic depression
Patient or population: adults with psychotic depression Setting: hospital Intervention: antidepressant Comparison: antipsychotic
Outcomes	Risk with antipsychotic	Risk with antidepressant	Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Clinical response of depression	Study population		RR 2.09 (0.64 to 6.82)	36 (1 RCT)	⊕⊝⊝⊝ Very low^a,b,c	Study defined depression response as HRSD‐17 < 7
Clinical response of depression	176 per 1000	369 per 1000 (113 to 1000)	RR 2.09 (0.64 to 6.82)	36 (1 RCT)	⊕⊝⊝⊝ Very low^a,b,c	Study defined depression response as HRSD‐17 < 7
Overall dropouts	Study population		RR 1.79 (0.18 to 18.02)	36 (1 RCT)	⊕⊝⊝⊝ Very low^a,b,c
Overall dropouts	59 per 1000	105 per 1000 (11 to 1000)	RR 1.79 (0.18 to 18.02)	36 (1 RCT)	⊕⊝⊝⊝ Very low^a,b,c
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). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^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.

Summary of findings 4. Antidepressant compared to antipsychotic for psychotic depression

Ir a la tabla de la revisión

Summary of findings 5. Antidepressant plus antipsychotic compared to placebo for psychotic depression

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Antidepressant plus antipsychotic compared to placebo for psychotic depression
Patient or population: adults with psychotic depression Setting: at least first week of study in hospital Intervention: antidepressant plus antipsychotic Comparison: placebo
Outcomes	Risk with placebo	Risk with antidepressant plus antipsychotic	Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Clinical response of depression	Study population		RR 1.86 (1.23 to 2.82)	148 (2 RCTs)	⊕⊝⊝⊝ Very low^a,b,c	Both studies defined response as reduction in HAMD‐24 ≥ 50% at endpoint
Clinical response of depression	280 per 1000	521 per 1000 (344 to 790)	RR 1.86 (1.23 to 2.82)	148 (2 RCTs)	⊕⊝⊝⊝ Very low^a,b,c
Overall dropouts	Study population		RR 0.75 (0.48 to 1.18)	148 (2 RCTs)	⊕⊝⊝⊝ Very low^a,b,d
Overall dropouts	470 per 1000	353 per 1000 (226 to 555)	RR 0.75 (0.48 to 1.18)	148 (2 RCTs)	⊕⊝⊝⊝ Very low^a,b,d
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). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^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.

Summary of findings 5. Antidepressant plus antipsychotic compared to placebo for psychotic depression

Ir a la tabla de la revisión

Summary of findings 6. Antidepressant plus antipsychotic compared to placebo plus antipsychotic for psychotic depression

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Antidepressant plus antipsychotic compared to placebo plus antipsychotic for psychotic depression
Patient or population: adults with psychotic depression Setting: hospital (2 RCTs) or at least first week of study in hospital (2 RCTs) Intervention: antidepressant plus antipsychotic Comparison: placebo plus antipsychotic
Outcomes	Risk with placebo plus antipsychotic	Risk with antidepressant plus antipsychotic	Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Clinical response of depression	Study population		RR 1.83 (1.40 to 2.38)	447 (4 RCTs)	⊕⊕⊝⊝ Low^a,b	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
Clinical response of depression	266 per 1000	487 per 1000 (373 to 633)	RR 1.83 (1.40 to 2.38)	447 (4 RCTs)	⊕⊕⊝⊝ Low^a,b
Overall dropouts	Study population		RR 0.79 (0.63 to 1.01)	447 (4 RCTs)	⊕⊕⊝⊝ Very low^a,b,c
Overall dropouts	435 per 1000	344 per 1000 (274 to 440)	RR 0.79 (0.63 to 1.01)	447 (4 RCTs)	⊕⊕⊝⊝ Very low^a,b,c
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). CI: confidence interval; HAMD: Hamilton Depression Rating Scale; HRSD: Hamilton Rating Scale for Depression; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^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.

Summary of findings 6. Antidepressant plus antipsychotic compared to placebo plus antipsychotic for psychotic depression

Ir a la tabla de la revisión

Summary of findings 7. Antidepressant plus antipsychotic compared to placebo plus antidepressant for psychotic depression

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Antidepressant plus antipsychotic compared to placebo plus antidepressant for psychotic depression
Patient or population: adults with psychotic depression Setting: hospital Intervention: antidepressant plus antipsychotic Comparison: placebo plus antidepressant
Outcomes	Risk with placebo plus antidepressant	Risk with antidepressant plus antipsychotic	Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Clinical response of depression	Study population		RR 1.42 (1.11 to 1.80)	245 (4 RCTs)	⊕⊕⊝⊝ Very low^a,b,c	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%
Clinical response of depression	436 per 1000	619 per 1000 (484 to 784)	RR 1.42 (1.11 to 1.80)	245 (4 RCTs)	⊕⊕⊝⊝ Very low^a,b,c
Overall dropouts	Study population		RR 0.91 (0.55 to 1.50)	245 (4 RCTs)	⊕⊝⊝⊝ Very low^a,b,d
Overall dropouts	207 per 1,000	189 per 1,000 (114 to 311)	RR 0.91 (0.55 to 1.50)	245 (4 RCTs)	⊕⊝⊝⊝ Very low^a,b,d
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). CI: confidence interval; HAMD: Hamilton Depression Rating Scale; HRSD: Hamilton Rating Scale for Depression; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^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.

Summary of findings 7. Antidepressant plus antipsychotic compared to placebo plus antidepressant for psychotic depression

Ir a la tabla de la revisión

Summary of findings 8. Antidepressant plus antipsychotic compared to placebo plus the same antidepressant for psychotic depression

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Antidepressant plus antipsychotic compared to placebo plus the same antidepressant for psychotic depression
Patient or population: adults with psychotic depression Setting: hospital Intervention: antidepressant plus antipsychotic Comparison: placebo plus the same antidepressant
Outcomes	Risk with placebo plus the same antidepressant	Risk with antidepressant plus antipsychotic	Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
Clinical response of depression	Study population		RR 1.70 (1.19 to 2.43)	157 (3 RCTs)	⊕⊕⊝⊝ Very low^a,b,c	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
Clinical response of depression	351 per 1000	596 per 1000 (417 to 852)	RR 1.70 (1.19 to 2.43)	157 (3 RCTs)	⊕⊕⊝⊝ Very low^a,b,c
Overall dropouts	Study population		RR 1.04 (0.52 to 2.07)	157 (3 RCTs)	⊕⊝⊝⊝ Very low^a,b,d
Overall dropouts	169 per 1000	176 per 1000 (88 to 349)	RR 1.04 (0.52 to 2.07)	157 (3 RCTs)	⊕⊝⊝⊝ Very low^a,b,d
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). CI: confidence interval; HAMD: Hamilton Depression Rating Scale; HRSD: Hamilton Rating Scale for Depression; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^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.

Summary of findings 8. Antidepressant plus antipsychotic compared to placebo plus the same antidepressant for psychotic depression

Ir a la tabla de la revisión

Comparison 1. Antidepressant versus placebo

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]

Comparison 1. Antidepressant versus placebo

Ir a la tabla de la revisión

Comparison 2. Antipsychotic versus placebo

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]

Comparison 2. Antipsychotic versus placebo

Ir a la tabla de la revisión

Comparison 3. Antidepressant versus antidepressant

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

Comparison 3. Antidepressant versus antidepressant

Ir a la tabla de la revisión

Comparison 4. Antidepressant versus antipsychotic

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]

Comparison 4. Antidepressant versus antipsychotic

Ir a la tabla de la revisión

Comparison 5. Antidepressant plus antipsychotic versus placebo

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]

Comparison 5. Antidepressant plus antipsychotic versus placebo

Ir a la tabla de la revisión

Comparison 6. Antidepressant plus antipsychotic versus placebo plus antipsychotic

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]

Comparison 6. Antidepressant plus antipsychotic versus placebo plus antipsychotic

Ir a la tabla de la revisión

Comparison 7. Antidepressant plus antipsychotic versus placebo plus antidepressant

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]

Comparison 7. Antidepressant plus antipsychotic versus placebo plus antidepressant

Ir a la tabla de la revisión

Comparison 8. Antidepressant plus antipsychotic versus placebo plus the same antidepressant

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]

Comparison 8. Antidepressant plus antipsychotic versus placebo plus the same antidepressant

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet