Hybrid systematic review and network meta-analysis of randomized controlled trials of interventions for depressive symptoms in patients with coronary artery disease

Frank Doyle; Kenneth E Freedland; Robert M Carney; Peter de Jonge; Chris Dickens; Susanne S Pedersen; Jan Sorensen; Martin Dempster

doi:10.1097/PSY.0000000000000944

Hybrid systematic review and network meta-analysis of randomized controlled trials of interventions for depressive symptoms in patients with coronary artery disease

Frank Doyle^*, Kenneth E Freedland, Robert M Carney, Peter de Jonge, Chris Dickens, Susanne S Pedersen, Jan Sorensen, Martin Dempster

^*Corresponding author for this work

Developmental Psychology

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVE: Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy.

METHODS: We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8-weeks post-treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random effects network meta-analysis was used to synthesize the evidence and evidence quality was evaluated following GRADE recommendations.

RESULTS: Thirty-three RCTs (7240 participants) provided analyzable data. All treatments were equally acceptable. At 8-weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26-weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. GRADE ratings ranged from very low to low.

CONCLUSIONS: Overall, the evidence was limited and biased. While all treatments for post-CAD depression were equally acceptable, antidepressants have the most robust evidence base and should be the first-line treatment. Combinations of antidepressants and psychotherapy, along with exercise, could be more effective than antidepressants alone, but require further rigorous, multi-arm intervention trials.

SYSTEMATIC REVIEW REGISTRATION: CRD42018108293 (PROSPERO).

Original language	English
Pages (from-to)	423-431
Number of pages	9
Journal	Psychosomatic Medicine
Volume	83
Issue number	5
DOIs	https://doi.org/10.1097/PSY.0000000000000944
Publication status	Published - 1-Jun-2021

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Hybrid Systematic Review and Network Meta-Analysis of Randomized Controlled Trials of Interventions for Depressive Symptoms in Patients With Coronary Artery DiseaseFinal publisher's version, 994 KBLicence: Taverne

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Doyle, F., Freedland, K. E., Carney, R. M., de Jonge, P., Dickens, C., Pedersen, S. S., Sorensen, J., & Dempster, M. (2021). Hybrid systematic review and network meta-analysis of randomized controlled trials of interventions for depressive symptoms in patients with coronary artery disease. Psychosomatic Medicine, 83(5), 423-431. https://doi.org/10.1097/PSY.0000000000000944

@article{3149200defde415cb3aa7b69bb4c2687,

title = "Hybrid systematic review and network meta-analysis of randomized controlled trials of interventions for depressive symptoms in patients with coronary artery disease",

abstract = "OBJECTIVE: Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy.METHODS: We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8-weeks post-treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random effects network meta-analysis was used to synthesize the evidence and evidence quality was evaluated following GRADE recommendations.RESULTS: Thirty-three RCTs (7240 participants) provided analyzable data. All treatments were equally acceptable. At 8-weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26-weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. GRADE ratings ranged from very low to low.CONCLUSIONS: Overall, the evidence was limited and biased. While all treatments for post-CAD depression were equally acceptable, antidepressants have the most robust evidence base and should be the first-line treatment. Combinations of antidepressants and psychotherapy, along with exercise, could be more effective than antidepressants alone, but require further rigorous, multi-arm intervention trials.SYSTEMATIC REVIEW REGISTRATION: CRD42018108293 (PROSPERO).",

author = "Frank Doyle and Freedland, {Kenneth E} and Carney, {Robert M} and {de Jonge}, Peter and Chris Dickens and Pedersen, {Susanne S} and Jan Sorensen and Martin Dempster",

note = "Copyright {\textcopyright} 2021 by American Psychosomatic Society.",

year = "2021",

month = jun,

day = "1",

doi = "10.1097/PSY.0000000000000944",

language = "English",

volume = "83",

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Doyle, F, Freedland, KE, Carney, RM, de Jonge, P, Dickens, C, Pedersen, SS, Sorensen, J & Dempster, M 2021, 'Hybrid systematic review and network meta-analysis of randomized controlled trials of interventions for depressive symptoms in patients with coronary artery disease', Psychosomatic Medicine, vol. 83, no. 5, pp. 423-431. https://doi.org/10.1097/PSY.0000000000000944

Hybrid systematic review and network meta-analysis of randomized controlled trials of interventions for depressive symptoms in patients with coronary artery disease. / Doyle, Frank; Freedland, Kenneth E; Carney, Robert M et al.
In: Psychosomatic Medicine, Vol. 83, No. 5, 01.06.2021, p. 423-431.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Hybrid systematic review and network meta-analysis of randomized controlled trials of interventions for depressive symptoms in patients with coronary artery disease

AU - Doyle, Frank

AU - Freedland, Kenneth E

AU - Carney, Robert M

AU - de Jonge, Peter

AU - Dickens, Chris

AU - Pedersen, Susanne S

AU - Sorensen, Jan

AU - Dempster, Martin

PY - 2021/6/1

Y1 - 2021/6/1

N2 - OBJECTIVE: Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy.METHODS: We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8-weeks post-treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random effects network meta-analysis was used to synthesize the evidence and evidence quality was evaluated following GRADE recommendations.RESULTS: Thirty-three RCTs (7240 participants) provided analyzable data. All treatments were equally acceptable. At 8-weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26-weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. GRADE ratings ranged from very low to low.CONCLUSIONS: Overall, the evidence was limited and biased. While all treatments for post-CAD depression were equally acceptable, antidepressants have the most robust evidence base and should be the first-line treatment. Combinations of antidepressants and psychotherapy, along with exercise, could be more effective than antidepressants alone, but require further rigorous, multi-arm intervention trials.SYSTEMATIC REVIEW REGISTRATION: CRD42018108293 (PROSPERO).

AB - OBJECTIVE: Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy.METHODS: We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8-weeks post-treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random effects network meta-analysis was used to synthesize the evidence and evidence quality was evaluated following GRADE recommendations.RESULTS: Thirty-three RCTs (7240 participants) provided analyzable data. All treatments were equally acceptable. At 8-weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26-weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. GRADE ratings ranged from very low to low.CONCLUSIONS: Overall, the evidence was limited and biased. While all treatments for post-CAD depression were equally acceptable, antidepressants have the most robust evidence base and should be the first-line treatment. Combinations of antidepressants and psychotherapy, along with exercise, could be more effective than antidepressants alone, but require further rigorous, multi-arm intervention trials.SYSTEMATIC REVIEW REGISTRATION: CRD42018108293 (PROSPERO).

U2 - 10.1097/PSY.0000000000000944

DO - 10.1097/PSY.0000000000000944

M3 - Article

C2 - 34074982

SN - 0033-3174

VL - 83

SP - 423

EP - 431

JO - Psychosomatic Medicine

JF - Psychosomatic Medicine

IS - 5

ER -

Hybrid systematic review and network meta-analysis of randomized controlled trials of interventions for depressive symptoms in patients with coronary artery disease

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