It can be hard to detect and treat depression when it occurs in palliative care because it often presents amongst a multitude of other symptoms.
There are obviously many systematic reviews that assess the use of antidepressants as a treatment for various life threatening illnesses, but no previous study has synthesized the evidence in palliative care. The objective of this study was to determine the efficacy of antidepressants for the treatment of depression in this specialised area of healthcare that focuses on relieving and preventing the suffering of patients.
The authors found 25 RCTs comparing antidepressants and placebo for the treatment of depression in palliative care. The primary outcome was efficacy assessed at three time-points. At each time-point antidepressants were more efficacious than placebo:
- 4-5 weeks odds ratio (OR) 1.93 (1.15-3.42) p = 0.001
- 6-8 weeks OR 2.25 (1.38-3.67) p = 0.001
- 9-18 weeks OR 2.71 (1.50-4.91) p = 0.001
The research team concluded:
This review provides evidence that antidepressants are effective in treating depression in palliative care. Their superiority over placebo is apparent within 4-5 weeks and increases with continued use. It is probable that the effect sizes yielded in this review overestimate the efficacy of antidepressants due to biases such as selective reporting and publication. Nevertheless, the magnitude and consistency of the effect suggests genuine benefit.
Rayner L, Price A, Evans A, Valsraj K, Hotopf M, Higginson IJ. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med. 2011 Jan;25(1):36-51. Epub 2010 Oct 8. [PubMed abstract]