Evidence map›Paper›PMID 25583895›Full record

SynthesisAnnals of family medicine

Efficacy and acceptability of pharmacological treatments for depressive disorders in primary care: systematic review and network meta-analysis.

Klaus Linde, Levente Kriston, Gerta Rücker, Susanne Jamil, Isabelle Schumann, Karin Meissner, Kirsten Sigterman, Antonius Schneider

Open access · diamondAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
51citing papers in PubMed, 10 pooled it
22.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

51 citing papers in PubMed, 10 syntheses or guidelines pooled it, 147 citations in OpenAlex.

  1. Efficacy of eHealth Interventions for Adults with Diabetes: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Klaus LindeInstitute of General Practice, Technische Universität München, Munich, Germany Klaus.Linde@tum.de.
Levente KristonDepartment of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Gerta RückerInstitute of Medical Biometry and Statistics, University Medical Center Freiburg, Freiburg, Germany.
Susanne JamilInstitute of General Practice, Technische Universität München, Munich, Germany.
Isabelle SchumannInstitute of General Practice, Technische Universität München, Munich, Germany.
Karin MeissnerInstitute of General Practice, Technische Universität München, Munich, Germany Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Munich, Germany.
Kirsten SigtermanInstitute of General Practice, Technische Universität München, Munich, Germany.
Antonius SchneiderInstitute of General Practice, Technische Universität München, Munich, Germany.
Technical University of Munich · DELudwig-Maximilians-Universität München · DEUniversität Hamburg · DEUniversity Medical Center Freiburg · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe purpose of this study was to investigate whether antidepressants are more effective than placebo in the primary care setting, and whether there are differences between substance classes regarding efficacy and acceptability.

methodsWe conducted literature searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO up to December 2013. Randomized trials in depressed adults treated by primary care physicians were included in the review. We performed both conventional pairwise meta-analysis and network meta-analysis combining direct and indirect evidence. Main outcome measures were response and study discontinuation due to adverse effects.

resultsA total of 66 studies with 15,161 patients met the inclusion criteria. In network meta-analysis, tricyclic and tetracyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), a serotonin-noradrenaline reuptake inhibitor (SNRI; venlafaxine), a low-dose serotonin antagonist and reuptake inhibitor (SARI; trazodone) and hypericum extracts were found to be significantly superior to placebo, with estimated odds ratios between 1.69 and 2.03. There were no statistically significant differences between these drug classes. Reversible inhibitors of monoaminoxidase A (rMAO-As) and hypericum extracts were associated with significantly fewer dropouts because of adverse effects compared with TCAs, SSRIs, the SNRI, a noradrenaline reuptake inhibitor (NRI), and noradrenergic and specific serotonergic antidepressant agents (NaSSAs).

conclusionsCompared with other drugs, TCAs and SSRIs have the most solid evidence base for being effective in the primary care setting, but the effect size compared with placebo is relatively small. Further agents (hypericum, rMAO-As, SNRI, NRI, NaSSAs, SARI) showed some positive results, but limitations of the currently available evidence makes a clear recommendation on their place in clinical practice difficult.

Indexed as

Patient Acceptance of Health CareAntidepressive AgentsDepressive DisorderHumansPrimary Health CareTreatment OutcomeAntidepressive Agentsantidepressive agentsdepressiondepressive disordersprimary health carereviewsystematic

Identifiers

PMID25583895
PMCPMC4291268
OpenAlexW2144370541

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.