Abstract
IntroductionPharmacotherapy plays an important role in the treatment of major depression. At the initiation of antidepressant treatment, both improvement of symptoms in the short term and relapse prevention in the long term should be taken into account. However, there is insufficient evidence regarding the efficacy and the acceptability of continuation/maintenance treatments and the relative efficacy/acceptability of antidepressants.ObjectiveWe will conduct a pairwise meta-analysis and a network meta-analysis (NMA) to examine the relative efficacy, tolerability and acceptability of antidepressants in the long-term treatment of major depression.Methods and analysisWe will include double-blind randomised controlled trials comparing any of the following antidepressants, which we included in our previous NMA of the acute treatment for major depression, with placebo or with another active drug for long-term treatment of major depression: agomelatine, amitriptyline, bupropion, citalopram, clomipramine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, trazodone, venlafaxine, vilazodone and vortioxetine. Our primary outcomes will be sustained response and all-cause dropouts. We will include four types of designs that are used to investigate long-term treatment. We will conduct two main analyses. First, we will conduct a pairwise meta-analysis comparing all antidepressants versus placebo to investigate whether continuing antidepressants after achieving a positive response in the acute-phase treatment is beneficial and/or safe. Second, we will conduct an NMA to examine the comparative efficacy and acceptability of the drugs. We will use a novel approach that will combine the results of acute-phase treatment NMA with long-term treatment studies to include all related designs in the NMA. We will ensure the validity of combining different designs and our new approach by checking the distribution of important effect modifiers and consistency of network.Ethics and disseminationThis study did not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal.PROSPERO registration numberCRD42018114561; Pre-results.
Funder
National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre
NIHR Research Professorship
Reference48 articles.
1. World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. 2017. Licence: CC BY-NC-SA 3.0 IGO http://www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/ (accessed 26 Oct 2018).
2. The Epidemiology of Depression Across Cultures
3. Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010
4. World Health Organisation. Depression: fact sheet. Geneva, 2017. http://www.who.int/mediacentre/factsheets/fs369/en/. (Accessed 26 Oct 2018).
5. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis;Cipriani;Lancet,2018
Cited by
18 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献