Summary: While it is well-known antidepressants are effective at treating those with depression, a new study reports the medications may be beneficial as a preventative measure for those with a risk factor for depressive disorders.
Source: Keel University
Antidepressants are well established for use in the treatment of depression, but new research by Keele University has shown that they can potentially prevent the condition in people who are at high risk of developing depressive illness.
The study, led by Professor Saeed Farooq, found that using antidepressants as a pre-emptive measure could help to prevent depression in patients considered to be at high risk of developing the condition, for example following stroke or heart attack.
This is the first study to examine the effects of all available medicine-based interventions in preventing depression, with Professor Farooq and his colleagues looking at the results of a number of previous studies in this field to assess how effective these treatments are.
The 28 studies they analyzed considered a number of possible medical interventions for patients at high risk of developing depression, including antidepressants, hormone replacement therapies, and selenium, a mineral that has been linked to depression. The majority of the studies examined the effect of antidepressants in preventing depression associated with a stroke, Hepatitis C, or other physical conditions.
The analysis found that antidepressants were significantly more effective at preventing depression in these patients, compared to those who were given placebos.
While the researchers have said the results are promising, Professor Farooq said that further studies are needed using proper research designs. Most studies the researchers examined had relatively short follow-up periods, which is crucial as observation over a longer period of time is needed to establish the effectiveness of preventative treatments.
Professor Farooq added that this approach is not yet ready for use in routine clinical practice but needs to be tested in larger, well designed studies. He stressed that funding agencies such as Medical Research Council UK need to prioritize research using pharmacological agents in preventing rather than treating depression.
Professor Farooq said: “Our study represents a major public health advance for preventing depression and we are not aware of any research that has shown such a significant effect of antidepressants in preventing depression. If the findings are confirmed in future studies this will help to prevent a colossal burden of disease caused by depressive illness worldwide.”
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Keel University
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Original Research: Open access
“Pharmacological interventions for prevention of depression in high risk conditions: Systematic review and meta-analysis”. by Saeed Farooq et al.
Journal of Affective Disorders doi:10.1016/j.jad.2020.03.024
Abstract
Pharmacological interventions for prevention of depression in high risk conditions: Systematic review and meta-analysis
Background
Background Depressive disorders account for almost half of all Disability Adjusted Life Years caused by psychiatric disorders but efficacy of pharmacological interventions to prevent depressive disorders is not known. We aimed to assess efficacy of pharmacological treatments in prevention of depression.
Methods
We searched PubMed, Psych Info, EMBASE, and CINHAL from 1980 to January 2020 and bibliographies of relevant systematic reviews. We selected randomised controlled trials (RCTs) that used a pharmacological intervention to prevent the onset of the new depressive episode in adult population. Study selection, data extraction and reporting was done following PRISMA guidelines. Data were pooled using random-effects meta-analysis.
Results
28 trials (2745 participants) were included in meta-analysis. Antidepressants (22 studies), Selenium, Hormone Replacement Therapy Omega-3 fatty acids and Melatonin were used to prevent depression, mostly in physical conditions associated with high risk of depression. All pharmacological interventions [pooled Odds Ratios (OR) 0.37 CI (0.25–0.54)], and antidepressants (OR 0.29, 95% CI: 0.18, 0.46) were significantly more effective than placebo in preventing depression. Antidepressants were significantly better than placebo in trials that had low risk of bias (n = 16; OR 0.43 [0.30, 0.60]), in preventing post stroke depression (OR = 0.16, 95% CI: 0.05, 0.55) and depression associated with Hepatitis C (OR = 0.56, 95% CI: 0.31, 1.02).
Limitations include small number of studies focussed only on high risk conditions and short follow up in most studies.
Conclusions
Prevention of depression may be possible in patients who have high-risk conditions such as stroke but the strategy requires complete risk and benefits analysis before it can be considered for clinical practice.
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