Cochrane · systematic review · CD010557
Pharmacological interventions for treatment‐resistant depression in adults
Davies, P, Ijaz, S, Williams, CJ, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Common Mental DisordersAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
41
current version
GRADE rated
32
No studies
9
Included studies
NR
No studies 9 · 22%Ungraded 0 · 0%Very low 0 · 0%Low 13 · 31.7%Moderate 12 · 29.3%High 7 · 17.1%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Switching to mianserin (60 mg/d) compared to continuing on current antidepressant (fluoxetine 20 mg/d) for treatment‐resistant depression in adults
Population: treatment‐resistant depression in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depressive symptoms (HAM‐D) Scale from: 0 to 54 (worse) Switching to mianserin (60 mg/d) vs continuing on current antidepressant (fluoxetine 20 mg/d) | no estimate extracted | 1 study · 71 participants | Low Downgraded: imprecision |
Dropouts Switching to mianserin (60 mg/d) vs continuing on current antidepressant (fluoxetine 20 mg/d) | RR 2.08 [0.94, 4.59] | 1 study · 72 participants | Low Downgraded: imprecision |
Response (≥ 50% improvement in HAM‐D score) Switching to mianserin (60 mg/d) vs continuing on current antidepressant (fluoxetine 20 mg/d) | RR 1.32 [0.76, 2.27] | 1 study · 71 participants | Low Downgraded: imprecision |
Remission (HAM‐D total score ≤ 8) Switching to mianserin (60 mg/d) vs continuing on current antidepressant (fluoxetine 20 mg/d) | RR 1.97 [0.88, 4.42] | 1 study · 71 participants | Low Downgraded: imprecision |
Quality of life ‐ not measured Switching to mianserin (60 mg/d) vs continuing on current antidepressant (fluoxetine 20 mg/d) | no estimate extracted | NR | No studies |
Augmentation of current antidepressant (fluoxetine 20 mg/d) with mianserin (60 mg/d) compared to augmentation of current antidepressant (fluoxetine 20 mg/d) with placebo for treatment‐resistant depression in adults
Population: treatment‐resistant depression in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depressive symptoms (HAM‐D) Scale from: 0 to 54 (worse) Augmentation of current antidepressant (fluoxetine 20 mg/d) with mianserin (60 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d) with placebo | no estimate extracted | 1 study · 70 participants | Moderate Downgraded: imprecision |
Dropouts Augmentation of current antidepressant (fluoxetine 20 mg/d) with mianserin (60 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d) with placebo | RR 1.02 [0.38, 2.72] | 1 study · 70 participants | Low Downgraded: imprecision |
Response (≥ 50% reduction in HAM‐D score) Augmentation of current antidepressant (fluoxetine 20 mg/d) with mianserin (60 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d) with placebo | RR 1.7 [1.03, 2.78] | 1 study · 70 participants | Low Downgraded: imprecision |
Remission (HAM‐D total score ≤ 7) Augmentation of current antidepressant (fluoxetine 20 mg/d) with mianserin (60 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d) with placebo | RR 2.38 [1.09, 5.16] | 1 study · 70 participants | Low Downgraded: imprecision |
Quality of life ‐ not measured Augmentation of current antidepressant (fluoxetine 20 mg/d) with mianserin (60 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d) with placebo | no estimate extracted | NR | No studies |
Augmentation of current antidepressant (SSRI/SNRI) with mirtazapine (30 mg/d) compared to augmentation of current antidepressant (SSRI/SNRI) therapy with placebo for treatment‐resistant depression in adults
Population: treatment‐resistant depression in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depressive symptoms (BDI‐II) Scale from: 0 to 64 (worse) Augmentation of current antidepressant (SSRI/SNRI) with mirtazapine (30 mg/d) vs augmentation of current antidepressant (SSRI/SNRI) therapy with placebo | no estimate extracted | 1 study · 431 participants | High |
Dropouts Augmentation of current antidepressant (SSRI/SNRI) with mirtazapine (30 mg/d) vs augmentation of current antidepressant (SSRI/SNRI) therapy with placebo | RR 0.5 [0.15, 1.62] | 1 study · 480 participants | High |
Response (≥ 50% improvement in BDI‐II score) Augmentation of current antidepressant (SSRI/SNRI) with mirtazapine (30 mg/d) vs augmentation of current antidepressant (SSRI/SNRI) therapy with placebo | RR 1.22 [0.97, 1.54] | 1 study · 431 participants | High |
Remission (BDI‐II total score ≤ 9) Augmentation of current antidepressant (SSRI/SNRI) with mirtazapine (30 mg/d) vs augmentation of current antidepressant (SSRI/SNRI) therapy with placebo | RR 1.21 [0.88, 1.65] | 1 study · 431 participants | High |
Quality of life (EQ‐5D‐5L) ‐ 12 weeks Augmentation of current antidepressant (SSRI/SNRI) with mirtazapine (30 mg/d) vs augmentation of current antidepressant (SSRI/SNRI) therapy with placebo | no estimate extracted | 1 study · 447 participants | High |
Augmentation of current antidepressant (SSRI) with busiprone (20 mg/d to 60 mg/d) compared to augmentation of current antidepressant (SSRI) with placebo for treatment‐resistant depression in adults
Population: treatment‐resistant depression in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depressive symptoms (MADRS) Scale from: 0 to 60 (worse) Augmentation of current antidepressant (SSRI) with busiprone (20 mg/d to 60 mg/d) vs augmentation of current antidepressant (SSRI) with placebo | no estimate extracted | 1 study · 102 participants | Low Downgraded: imprecision |
Dropouts Augmentation of current antidepressant (SSRI) with busiprone (20 mg/d to 60 mg/d) vs augmentation of current antidepressant (SSRI) with placebo | RR 0.6 [0.23, 1.53] | 1 study · 108 participants | Low Downgraded: imprecision |
Response to treatment ‐ not measured Augmentation of current antidepressant (SSRI) with busiprone (20 mg/d to 60 mg/d) vs augmentation of current antidepressant (SSRI) with placebo | no estimate extracted | NR | No studies |
Remission ‐ not measured Augmentation of current antidepressant (SSRI) with busiprone (20 mg/d to 60 mg/d) vs augmentation of current antidepressant (SSRI) with placebo | no estimate extracted | NR | No studies |
Quality of life ‐ not measured Augmentation of current antidepressant (SSRI) with busiprone (20 mg/d to 60 mg/d) vs augmentation of current antidepressant (SSRI) with placebo | no estimate extracted | NR | No studies |
Augmentation of current antidepressant (various) with cariprazine (1 mg/d to 4.5 mg/d) compared to augmentation of current antidepressant (various) with placebo for treatment‐resistant depression in adults
Population: treatment‐resistant depression in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depressive symptoms (MADRS) ‐ Any dose Scale from: 0 to 60 (worse) Augmentation of current antidepressant (various) with cariprazine (1 mg/d to 4.5 mg/d) vs augmentation of current antidepressant (various) with placebo | no estimate extracted | 1 study · 808 participants | High |
Dropouts ‐ any dose Augmentation of current antidepressant (various) with cariprazine (1 mg/d to 4.5 mg/d) vs augmentation of current antidepressant (various) with placebo | RR 1.68 [1.16, 2.41] | 1 study · 821 participants | Moderate Downgraded: imprecision |
Response (≥ 50% improvement in MADRS score) ‐ any dose Augmentation of current antidepressant (various) with cariprazine (1 mg/d to 4.5 mg/d) vs augmentation of current antidepressant (various) with placebo | RR 1.27 [1.07, 1.52] | 1 study · 808 participants | Moderate Downgraded: imprecision |
Remission (MADRS total score ≤ 10) ‐ any dose Augmentation of current antidepressant (various) with cariprazine (1 mg/d to 4.5 mg/d) vs augmentation of current antidepressant (various) with placebo | RR 1.07 [0.86, 1.33] | 1 study · 808 participants | Moderate Downgraded: imprecision |
Quality of life ‐ not measured Augmentation of current antidepressant (various) with cariprazine (1 mg/d to 4.5 mg/d) vs augmentation of current antidepressant (various) with placebo | no estimate extracted | NR | No studies |
Augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with olanzapine (5 mg/d to 20 mg/d) compared to augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with placebo for treatment‐resistant depression in adults
Population: treatment‐resistant depression in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depressive symptoms (HAM‐D) Scale from: 0 to 52 (worse) Augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with olanzapine (5 mg/d to 20 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with placebo | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |
Depressive symptoms (MADRS) Scale from: 0 to 60 (worse) Augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with olanzapine (5 mg/d to 20 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with placebo | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |
Dropouts Augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with olanzapine (5 mg/d to 20 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with placebo | RR 0.33 [0.04, 2.69] | 1 study · 20 participants | Low Downgraded: imprecision |
Response (≥50% reduction in MADRS score) Augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with olanzapine (5 mg/d to 20 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with placebo | RR 6 [0.87, 41.21] | 1 study · 20 participants | Low Downgraded: imprecision |
Remission ‐ not reported Augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with olanzapine (5 mg/d to 20 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with placebo | no estimate extracted | NR | No studies |
Quality of life ‐ not measured Augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with olanzapine (5 mg/d to 20 mg/d) vs augmentation of current antidepressant (fluoxetine 20 mg/d to 60 mg/d) with placebo | no estimate extracted | NR | No studies |
Augmentation of current antidepressant (various) with quetiapine (150 mg/d to 300 mg/d) compared to augmentation of current antidepressant (various) with placebo for treatment‐resistant depression in adults
Population: treatment‐resistant depression in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depressive symptoms (MADRS or HAM‐D) ‐ Any dose Augmentation of current antidepressant (various) with quetiapine (150 mg/d to 300 mg/d) vs augmentation of current antidepressant (various) with placebo | no estimate extracted | 3 studies · 977 participants | High |
Dropouts ‐ Any dose Augmentation of current antidepressant (various) with quetiapine (150 mg/d to 300 mg/d) vs augmentation of current antidepressant (various) with placebo | RR 1.33 [0.9, 1.95] | 3 studies · 997 participants | Moderate Downgraded: imprecision |
Response (≥ 50% reduction in MADRS or HAM‐D score) ‐ Any dose Augmentation of current antidepressant (various) with quetiapine (150 mg/d to 300 mg/d) vs augmentation of current antidepressant (various) with placebo | RR 1.25 [1.09, 1.44] | 3 studies · 977 participants | Moderate Downgraded: imprecision |
Remission (MADRS score ≤ 8/HAM‐D score ≤ 7) ‐ Any dose Augmentation of current antidepressant (various) with quetiapine (150 mg/d to 300 mg/d) vs augmentation of current antidepressant (various) with placebo | RR 1.53 [1.23, 1.9] | 3 studies · 977 participants | Moderate Downgraded: imprecision |
Quality of life (% max score of Q‐LES‐Q‐SF) ‐ Any dose Scale from: 0 to 100 (better) Augmentation of current antidepressant (various) with quetiapine (150 mg/d to 300 mg/d) vs augmentation of current antidepressant (various) with placebo | no estimate extracted | 2 studies · 884 participants | Moderate Downgraded: imprecision |
Augmentation of current antidepressant (SSRI) with ziprasidone (40 mg/d to 160 mg/d) compared to augmentation of current antidepressant (SSRI) with placebo or continue on SSRI monotherapy for treatment‐resistant depression in adults
Population: treatment‐resistant depression in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depressive symptoms (HAM‐D) ‐ Any dose Scale from: 0 to 54 (worse) Augmentation of current antidepressant (SSRI) with ziprasidone (40 mg/d to 160 mg/d) vs augmentation of current antidepressant (SSRI) with placebo or continue on SSRI monotherapy | no estimate extracted | 2 studies · 199 participants | Moderate Downgraded: imprecision |
Dropouts ‐ Any dose Augmentation of current antidepressant (SSRI) with ziprasidone (40 mg/d to 160 mg/d) vs augmentation of current antidepressant (SSRI) with placebo or continue on SSRI monotherapy | RR 1.6 [1.01, 2.55] | 2 studies · 199 participants | Moderate Downgraded: imprecision |
Response (≥ 50% reduction in MADRS/HAM‐D score) ‐ Any dose Augmentation of current antidepressant (SSRI) with ziprasidone (40 mg/d to 160 mg/d) vs augmentation of current antidepressant (SSRI) with placebo or continue on SSRI monotherapy | RR 1.8 [1.07, 3.04] | 2 studies · 199 participants | Moderate Downgraded: imprecision |
Remission (clinician‐rated) ‐ Any dose Augmentation of current antidepressant (SSRI) with ziprasidone (40 mg/d to 160 mg/d) vs augmentation of current antidepressant (SSRI) with placebo or continue on SSRI monotherapy | OR 1.46 [0.75, 2.86] | 2 studies · 199 participants | Moderate Downgraded: imprecision |
Quality of life ‐ not measured Augmentation of current antidepressant (SSRI) with ziprasidone (40 mg/d to 160 mg/d) vs augmentation of current antidepressant (SSRI) with placebo or continue on SSRI monotherapy | no estimate extracted | NR | No studies |