Antidepressants available in Japan for older people with major depressive disorder: A systematic review and meta‐analysis

Abstract

AbstractAimTo update the major depressive disorder (MDD) treatment guidelines of the Japanese Society of Mood Disorders, we conducted a systematic review and pairwise meta‐analysis of double‐blind, randomized, placebo‐controlled trials of available antidepressants in Japan for older adults with MDD.MethodsOutcome measures included response rate (primary), improvement in depressive symptom scale score, remission rate, all‐cause discontinuation, discontinuation due to adverse events, and at least one adverse event. A random‐effects model was used to calculate the risk ratio (RR) and standardized mean difference (SMD) with a 95% confidence interval (95% CI).ResultsNine double‐blind, randomized, placebo‐controlled trials (n = 2145) were identified. No study has been conducted in Japan. Our meta‐analysis included the following antidepressants: duloxetine, escitalopram, imipramine, sertraline, venlafaxine, and vortioxetine. Antidepressants have significantly higher response rates than placebo (RR [95% CI] = 1.38 [1.04, 1.83], p = 0.02). Antidepressants outperformed placebo in terms of improving depressive symptom scale score (SMD [95% CI] = −0.62 [−0.92, −0.33], p < 0.0001). However, antidepressants were associated with a higher discontinuation rate due to adverse events (RR [95% CI] = 1.94 [1.30, 2.88], p = 0.001) and a higher incidence of at least one adverse event (RR [95% CI] = 1.11 [1.02, 1.21], p = 0.02) compared to placebo. The groups did not differ significantly in terms of remission rate or all‐cause discontinuation.ConclusionsOur meta‐analysis concluded that treatment with antidepressants available in Japan is only weakly recommended for moderate to severe MDD in older adults.