TY - JOUR
T1 - Relative effectiveness of augmentation treatments for treatment-resistant depression: a systematic review and network meta-analysis
AU - Carter, Ben
AU - Strawbridge, Rebecca
AU - Husain, Ishrat
AU - Jones, Brett D.M.
AU - Short, Roxanna
AU - Cleare, Anthony
AU - Tsapekos, Dimosthenis
AU - Patrick, Fiona
AU - Marwood, Lindsey
AU - Taylor, Rachael
AU - Mantingh, Tim
AU - De Angel, Valeria
AU - Nikolova, Viktoriya
AU - Andre F. Carvalho, null
AU - Young, Allan
PY - 2020/8/17
Y1 - 2020/8/17
N2 - Most interventions for treatment-resistant depression (TRD) are added as augmenters. We aimed to determine the relative effectiveness of augmentation treatments for TRD. This systematic review and network meta-analysis (NMA) sought all randomized trials of pharmacological and psychological augmentation interventions for adults meeting the most common clinical criteria for TRD. The NMA compared the intervention effectiveness of depressive symptoms for TRD augmentation. Of 36 included trials, 27 were suitable for inclusion in NMA, and no psychological trials could be included in the absence of a common comparator. Antipsychotics (13 trials), mood stabilizers (three trials), NMDA-targeting medications (five trials), and other mechanisms (3 trials) were compared against placebo. NMDA treatments were markedly superior to placebo (ES = 0.91, 95% CI 0.67 to 1.16) and head-to-head NMA suggested that NMDA therapies had the highest chance of being an effective treatment option compared to other pharmacological classes. This study provides the most comprehensive evidence of augmenters’ effectiveness for TRD, and our GRADE recommendations can be used to guide guidelines to optimize treatment choices. Although conclusions are limited by paucity of, and heterogeneity between, trials as well as inconsistent reports of treatment safety. This work supports the use of NMDA-targeting medications such as ketamine.
AB - Most interventions for treatment-resistant depression (TRD) are added as augmenters. We aimed to determine the relative effectiveness of augmentation treatments for TRD. This systematic review and network meta-analysis (NMA) sought all randomized trials of pharmacological and psychological augmentation interventions for adults meeting the most common clinical criteria for TRD. The NMA compared the intervention effectiveness of depressive symptoms for TRD augmentation. Of 36 included trials, 27 were suitable for inclusion in NMA, and no psychological trials could be included in the absence of a common comparator. Antipsychotics (13 trials), mood stabilizers (three trials), NMDA-targeting medications (five trials), and other mechanisms (3 trials) were compared against placebo. NMDA treatments were markedly superior to placebo (ES = 0.91, 95% CI 0.67 to 1.16) and head-to-head NMA suggested that NMDA therapies had the highest chance of being an effective treatment option compared to other pharmacological classes. This study provides the most comprehensive evidence of augmenters’ effectiveness for TRD, and our GRADE recommendations can be used to guide guidelines to optimize treatment choices. Although conclusions are limited by paucity of, and heterogeneity between, trials as well as inconsistent reports of treatment safety. This work supports the use of NMDA-targeting medications such as ketamine.
KW - NMDA antagonists
KW - Treatment resistant depression
KW - antipsychotics
KW - mood stabilisers
KW - network meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85086876769&partnerID=8YFLogxK
U2 - 10.1080/09540261.2020.1765748
DO - 10.1080/09540261.2020.1765748
M3 - Review article
SN - 0954-0261
VL - 32
SP - 477
EP - 490
JO - International Review of Psychiatry
JF - International Review of Psychiatry
IS - 5-6
ER -
