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Comparative efficacy of pharmacological treatments on measures of self-rated functional outcomes using the Sheehan Disability Scale in patients with major depressive disorder: a systematic review and network meta-analysis

Published online by Cambridge University Press:  15 February 2021

Bing Cao Open the ORCID record for Bing Cao [Opens in a new window] ,
Lu Xu ,
Yan Chen ,
Dongfang Wang ,
Yena Lee ,
Joshua D. Rosenblat ,
Xiao Gao ,
Siyan Zhan ,
Feng Sun  and
Roger S. McIntyre Open the ORCID record for Roger S. McIntyre [Opens in a new window]
Bing Cao*
Affiliation:
Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, China
Lu Xu
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing100191, China
Yan Chen
Affiliation:
Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, Canada
Dongfang Wang
Affiliation:
Chongqing Blood Center, Chongqing, China
Yena Lee
Affiliation:
Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Joshua D. Rosenblat
Affiliation:
Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Xiao Gao
Affiliation:
Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, China
Siyan Zhan
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing100191, China Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
Feng Sun*
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing100191, China
Roger S. McIntyre
Affiliation:
Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
*
*Author for correspondence: Bing Cao, PhD, Email: [email protected]
*Feng Sun, PhD, Email: [email protected]
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Abstract

Objective

More than 50% patients with major depressive disorder (MDD) have severe functional impairment. The restoration of patient functioning is a critical therapeutic goal among patients with MDD. We conducted a systematic review and network meta-analysis to evaluate the efficacy of pharmacological treatments on self-rated functional outcomes using the Sheehan Disability Scale in adults with MDD in randomized clinical trials.

Methods

PubMed, EMBASE, PsycINFO, Cochrane Library, and ClinicalTrials.gov were searched from inception to December 10, 2019. Summary statistics are reported as weighted mean differences with 95% confidence intervals. Interventions were ranked using the surface under the cumulative ranking probabilities.

Results

We included 42 randomized controlled trials (RCTs) (n = 18 998) evaluating the efficacy of 13 different pharmacological treatments on functional outcomes, as measured by the Sheehan Disability Scale (SDS). Duloxetine was the most effective pharmacological agent on functional outcomes, followed by (ranked by efficacy): paroxetine, levomilnacipran, venlafaxine, quetiapine, desvenlafaxine, agomelatine, escitalopram, amitriptyline, bupropion, sertraline, vortioxetine, and fluoxetine. Serotonin and norepinephrine reuptake inhibitors were more effective than other drug classes. Additionally, the comparison-adjusted funnel plot suggested the publication bias between small and large studies was relatively low.

Conclusions

Our results indicate that there may be differences across antidepressant agents and classes with respect to self-reported functional outcomes. Validation and replication of these findings in large-scale RCTs are warranted. Our research results will be clinically useful for guiding psychiatrists in treating patients with MDD and functional impairment. PROSPERO registration number CRD42018116663.

Keywords

Antidepressantmajor depressive disorderfunctionnetwork meta-analysisSheehan Disability Scale
Type
Review
Information
CNS Spectrums , Volume 27 , Issue 4 , August 2022 , pp. 428 - 436
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Bing Cao and Lu Xu contributed equally to this work.

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