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Efficacy and acceptability of selective serotonin reuptake inhibitors for the treatment of depression in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.

Skapinakis P, Bakola E, Salanti G, Lewis G, Kyritsis AP, Mavreas V - BMC Neurol (2010)

Bottom Line: In the comparison between SSRIs and Tricyclic Antidepressants (TCAs) (n = 3 studies) the combined risk ratio was 0.75 (0.39 - 1.42, p = 0.37).An acceptability analysis showed that SSRIs were generally well tolerated.Due to the limited number of studies and the small sample sizes a type II error (false negative) cannot be excluded.

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Affiliation: Department of Psychiatry, University of Ioannina School of Medicine, Ioannina 45110, Greece. p.skapinakis@gmail.com

ABSTRACT

Background: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for the treatment of depression in patients with Parkinson's Disease (PD) but data on their efficacy are controversial.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials to investigate the efficacy and acceptability of SSRIs in the treatment of depression in PD.

Results: Ten studies were included. In the comparison between SSRIs and Placebo (n = 6 studies), the combined risk ratio (random effects) was 1.08 (95% confidence interval: 0.77 - 1.55, p = 0.67). In the comparison between SSRIs and Tricyclic Antidepressants (TCAs) (n = 3 studies) the combined risk ratio was 0.75 (0.39 - 1.42, p = 0.37). An acceptability analysis showed that SSRIs were generally well tolerated.

Conclusions: These results suggest that there is insufficient evidence to reject the hypothesis of no differences in efficacy between SSRIs and placebo in the treatment of depression in PD. Due to the limited number of studies and the small sample sizes a type II error (false negative) cannot be excluded. The comparison between SSRIs and TCAs is based on only three studies and further trials with more pragmatic design are needed.

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Risk Ratio for dropouts of SSRIs vs Placebo in Parkinson's Disease Patients.
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Figure 5: Risk Ratio for dropouts of SSRIs vs Placebo in Parkinson's Disease Patients.

Mentions: We first compared total dropouts in SSRIs vs. placebo. Five studies were included in this analysis as one small study had no dropouts. 17 out of 88 patients on SSRI dropped out (19.3%) vs. 12 out of 89 on placebo (13.5%). The combined risk ratio for dropouts was 1.28 with a 95% CI of 0.67 - 2.45 (figure 5). It should be noted that citalopram showed a greater tendency for increased dropout rates but this result was based on only two studies (combined risk ratio for citalopram 3.05, 95% CI 0.80 - 11.68, p = 0.10).


Efficacy and acceptability of selective serotonin reuptake inhibitors for the treatment of depression in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.

Skapinakis P, Bakola E, Salanti G, Lewis G, Kyritsis AP, Mavreas V - BMC Neurol (2010)

Risk Ratio for dropouts of SSRIs vs Placebo in Parkinson's Disease Patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2903535&req=5

Figure 5: Risk Ratio for dropouts of SSRIs vs Placebo in Parkinson's Disease Patients.
Mentions: We first compared total dropouts in SSRIs vs. placebo. Five studies were included in this analysis as one small study had no dropouts. 17 out of 88 patients on SSRI dropped out (19.3%) vs. 12 out of 89 on placebo (13.5%). The combined risk ratio for dropouts was 1.28 with a 95% CI of 0.67 - 2.45 (figure 5). It should be noted that citalopram showed a greater tendency for increased dropout rates but this result was based on only two studies (combined risk ratio for citalopram 3.05, 95% CI 0.80 - 11.68, p = 0.10).

Bottom Line: In the comparison between SSRIs and Tricyclic Antidepressants (TCAs) (n = 3 studies) the combined risk ratio was 0.75 (0.39 - 1.42, p = 0.37).An acceptability analysis showed that SSRIs were generally well tolerated.Due to the limited number of studies and the small sample sizes a type II error (false negative) cannot be excluded.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychiatry, University of Ioannina School of Medicine, Ioannina 45110, Greece. p.skapinakis@gmail.com

ABSTRACT

Background: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for the treatment of depression in patients with Parkinson's Disease (PD) but data on their efficacy are controversial.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials to investigate the efficacy and acceptability of SSRIs in the treatment of depression in PD.

Results: Ten studies were included. In the comparison between SSRIs and Placebo (n = 6 studies), the combined risk ratio (random effects) was 1.08 (95% confidence interval: 0.77 - 1.55, p = 0.67). In the comparison between SSRIs and Tricyclic Antidepressants (TCAs) (n = 3 studies) the combined risk ratio was 0.75 (0.39 - 1.42, p = 0.37). An acceptability analysis showed that SSRIs were generally well tolerated.

Conclusions: These results suggest that there is insufficient evidence to reject the hypothesis of no differences in efficacy between SSRIs and placebo in the treatment of depression in PD. Due to the limited number of studies and the small sample sizes a type II error (false negative) cannot be excluded. The comparison between SSRIs and TCAs is based on only three studies and further trials with more pragmatic design are needed.

Show MeSH
Related in: MedlinePlus