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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.

References

Kennedy, SH. Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues Clin Neurosci. 2008;10(3):271–277.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–3105. doi:10.1001/jama.289.23.3095.CrossRefGoogle Scholar
Hong, J, Novick, D, Moneta, MV, El-Shafei, A, Duenas, H, Haro, JM. Functional impairment and painful physical symptoms in patients with major depressive disorder treated with antidepressants: real-world evidence from the Middle East. Clin Pract Epidemiol Ment Health. 2017;13:145–155. doi:10.2174/1745017901713010145.CrossRefGoogle ScholarPubMed
Paykel, ES. Partial remission, residual symptoms, and relapse in depression. Dialogues Clin Neurosci. 2008;10(4):431–437.CrossRefGoogle ScholarPubMed
Hammer-Helmich, L, Haro, JM, Jonsson, B, et al. Functional impairment in patients with major depressive disorder: the 2-year PERFORM study. Neuropsychiatr Dis Treat. 2018;14:239–249. doi:10.2147/NDT.S146098.CrossRefGoogle ScholarPubMed
McIntyre, RS, Florea, I, Tonnoir, B, Loft, H, Lam, RW, Christensen, MC. Efficacy of vortioxetine on cognitive functioning in working patients with major depressive disorder. J Clin Psychiatry. 2017;78(1):115–121. doi:10.4088/JCP.16m10744.CrossRefGoogle ScholarPubMed
Sheehan, DV. Importance of restoring function in patients with major depressive disorder. J Clin Psychiatry. 2016;77(7):e908. doi:10.4088/JCP.14076tx2c.CrossRefGoogle ScholarPubMed
Oluboka, OJ, Katzman, MA, Habert, J, et al. Functional recovery in major depressive disorder: providing early optimal treatment for the individual patient. Int J Neuropsychopharmacol. 2018;21(2):128–144. doi:10.1093/ijnp/pyx081.CrossRefGoogle ScholarPubMed
Rosenblat, JD, Simon, GE, Sachs, GS, et al. Treatment effectiveness and tolerability outcomes that are most important to individuals with bipolar and unipolar depression. J Affect Disord. 2019;243:116–120. doi:10.1016/j.jad.2018.09.027.CrossRefGoogle ScholarPubMed
Gautam, S, Jain, A, Gautam, M, Vahia, VN, Grover, S. Clinical practice guidelines for the management of depression. Indian J Psychiatry. 2017;59(Suppl 1):S34–S50. doi:10.4103/0019-5545.196973.Google ScholarPubMed
Kennedy, SH, Lam, RW, McIntyre, RS, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. Pharmacological treatments. Can J Psychiatry. 2016;61(9):540–560. doi:10.1177/0706743716659417.CrossRefGoogle Scholar
Tran, BX, Ha, GH, Vu, GT, et al. Indices of change, expectations, and popularity of biological treatments for major depressive disorder between 1988 and 2017: a scientometric analysis. Int J Environ Res Public Health. 2019;16(13):1–15. doi:10.3390/ijerph16132255.CrossRefGoogle ScholarPubMed
Zimmerman, M, Posternak, MA, Chelminski, I. Derivation of a definition of remission on the Montgomery-Asberg Depression Rating Scale corresponding to the definition of remission on the Hamilton Rating Scale for Depression. J Psychiatr Res. 2004;38(6):577–582. doi:10.1016/j.jpsychires.2004.03.007.CrossRefGoogle Scholar
Carneiro, AM, Fernandes, F, Moreno, RA. Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale in depressed and bipolar I patients: psychometric properties in a Brazilian sample. Health Qual Life Outcomes. 2015;13:42. doi:10.1186/s12955-015-0235-3.CrossRefGoogle Scholar
Cipriani, A, Furukawa, TA, Salanti, G, et al. 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. Lancet. 2018;391(10128):1357–1366. doi:10.1016/S0140-6736(17)32802-7.CrossRefGoogle ScholarPubMed
Cipriani, A, Furukawa, TA, Salanti, G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009;373(9665):746–758. doi:10.1016/S0140-6736(09)60046-5.CrossRefGoogle ScholarPubMed
Kato, M, Serretti, A. Review and meta-analysis of antidepressant pharmacogenetic findings in major depressive disorder. Mol Psychiatry. 2010;15(5):473–500. doi:10.1038/mp.2008.116.CrossRefGoogle ScholarPubMed
Fournier, JC, DeRubeis, RJ, Hollon, SD, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303(1):47–53. doi:10.1001/jama.2009.1943.CrossRefGoogle ScholarPubMed
Sheehan, DV, Nakagome, K, Asami, Y, Pappadopulos, EA, Boucher, M. Restoring function in major depressive disorder: a systematic review. J Affect Disord. 2017;215:299–313. doi:10.1016/j.jad.2017.02.029.CrossRefGoogle ScholarPubMed
Lee, Y, Rosenblat, JD, Lee, J, et al. Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: a systematic review. J Affect Disord. 2018;227:406–415. doi:10.1016/j.jad.2017.11.003.CrossRefGoogle ScholarPubMed
McIntyre, RS, Woldeyohannes, HO, Soczynska, JK, et al. Anhedonia and cognitive function in adults with MDD: results from the International Mood Disorders Collaborative Project. CNS Spectr. 2016;21(5):362–366. doi:10.1017/S1092852915000747.CrossRefGoogle ScholarPubMed
Ulbricht, CM, Rothschild, AJ, Lapane, KL. Functional impairment and changes in depression subtypes for women in STAR*D: a latent transition analysis. J Womens Health (Larchmt). 2016;25(5):464–472. doi:10.1089/jwh.2015.5361.CrossRefGoogle ScholarPubMed
McIntyre, RS, Cha, DS, Soczynska, JK, et al. Cognitive deficits and functional outcomes in major depressive disorder: determinants, substrates, and treatment interventions. Depression Anxiety. 2013;30(6):515–527. doi:10.1002/da.22063.CrossRefGoogle ScholarPubMed
Sheehan, DV, Mancini, M, Wang, J, et al. Assessment of functional outcomes by Sheehan Disability Scale in patients with major depressive disorder treated with duloxetine versus selective serotonin reuptake inhibitors. Hum Psychopharmacol. 2016;31(1):53–63. doi:10.1002/hup.2500.CrossRefGoogle ScholarPubMed
Coles, T, Coon, C, DeMuro, C, McLeod, L, Gnanasakthy, A. Psychometric evaluation of the Sheehan Disability Scale in adult patients with attention-deficit/hyperactivity disorder. Neuropsychiatr Dis Treat. 2014;10:887–895. doi:10.2147/NDT.S55220.Google ScholarPubMed
Goldstein, DJ. Duloxetine in the treatment of major depressive disorder. Neuropsychiatr Dis Treat. 2007;3(2):193–209.CrossRefGoogle ScholarPubMed
Weiller, E, Weiss, C, Watling, CP, et al. Functioning outcomes with adjunctive treatments for major depressive disorder: a systematic review of randomized placebo-controlled studies. Neuropsychiatr Dis Treat. 2018;14:103–115. doi:10.2147/NDT.S146840.CrossRefGoogle ScholarPubMed
McKnight, PE, Kashdan, TB. The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research. Clin Psychol Rev. 2009;29(3):243–259. doi:10.1016/j.cpr.2009.01.005.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Group, P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097.CrossRefGoogle ScholarPubMed
Leppink, J, O’Sullivan, P, Winston, K. Effect size—large, medium, and small. Perspect Med Educ. 2016;5(6):347–349. doi:10.1007/s40037-016-0308-y.CrossRefGoogle Scholar
Bucher, HC, Guyatt, GH, Griffith, LE, Walter, SD. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol. 1997;50(6):683–691. doi:10.1016/s0895-4356(97)00049-8.CrossRefGoogle ScholarPubMed
Law, M, Jackson, D, Turner, R, Rhodes, K, Viechtbauer, W. Two new methods to fit models for network meta-analysis with random inconsistency effects. BMC Med Res Methodol. 2016;16:87. doi:10.1186/s12874-016-0184-5.CrossRefGoogle Scholar
Veroniki, AA, Mavridis, D, Higgins, JP, Salanti, G. Characteristics of a loop of evidence that affect detection and estimation of inconsistency: a simulation study. BMC Med Res Methodol. 2014;14:106. doi:10.1186/1471-2288-14-106.CrossRefGoogle ScholarPubMed
The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). 2011.Google Scholar
Shim, S, Yoon, BH, Shin, IS, Bae, JM. Network meta-analysis: application and practice using Stata. Epidemiol Health. 2017;39:e2017047. doi:10.4178/epih.e2017047.CrossRefGoogle ScholarPubMed
Montgomery, SA, Nielsen, RZ, Poulsen, LH, Haggstrom, L. A randomised, double-blind study in adults with major depressive disorder with an inadequate response to a single course of selective serotonin reuptake inhibitor or serotonin-noradrenaline reuptake inhibitor treatment switched to vortioxetine or agomelatine. Human Psychopharmacol. 2014;29(5):470–482. doi:10.1002/hup.2424.CrossRefGoogle ScholarPubMed
Soares, CN, Endicott, J, Boucher, M, Fayyad, RS, Guico-Pabia, CJ. Predictors of functional response and remission with desvenlafaxine 50 mg/d in patients with major depressive disorder. CNS Spect. 2014;19(6):519–527. doi:10.1017/s1092852914000066.CrossRefGoogle ScholarPubMed
Kennedy, SH, Heun, R, Avedisova, A, et al. Effect of agomelatine 25-50 mg on functional outcomes in patients with major depressive disorder. J Affect Disord. 2018;238:122–128. doi:10.1016/j.jad.2018.05.060.CrossRefGoogle Scholar
Blier, P, Gommoll, C, Chen, C, Kramer, K. Effects of levomilnacipran ER on noradrenergic symptoms, anxiety symptoms, and functional impairment in adults with major depressive disorder: post hoc analysis of 5 clinical trials. J Affect Disord. 2017;210:273–279. doi:10.1016/j.jad.2016.11.011.CrossRefGoogle ScholarPubMed
Kornstein, SG, Clayton, AH, Bao, W, Guico-Pabia, CJ. A pooled analysis of the efficacy of desvenlafaxine for the treatment of major depressive disorder in perimenopausal and postmenopausal women. J Women’s Health. 2015;24(4):281–290. doi:10.1089/jwh.2014.4900.CrossRefGoogle ScholarPubMed
Lu, Y, Ho, CS, McIntyre, RS, Wang, W, Ho, RC. Effects of vortioxetine and fluoxetine on the level of Brain Derived Neurotrophic Factors (BDNF) in the hippocampus of chronic unpredictable mild stress-induced depressive rats. Brain Res Bull. 2018;142:1–7. doi:10.1016/j.brainresbull.2018.06.007.CrossRefGoogle ScholarPubMed
Baune, BT, Brignone, M, Larsen, KG. A network meta-analysis comparing effects of various antidepressant classes on the Digit Symbol Substitution Test (DSST) as a measure of cognitive dysfunction in patients with major depressive disorder. Int J Neuropsychopharmacol. 2018;21(2):97–107. doi:10.1093/ijnp/pyx070.CrossRefGoogle ScholarPubMed
Christensen, MC, Loft, H, McIntyre, RS. Vortioxetine improves symptomatic and functional outcomes in major depressive disorder: a novel dual outcome measure in depressive disorders. J Affect Disord. 2018;227:787–794. doi:10.1016/j.jad.2017.11.081.CrossRefGoogle ScholarPubMed
Subramaniapillai, M, Mansur, RB, Zuckerman, H, et al. Association between cognitive function and performance on effort based decision making in patients with major depressive disorder treated with vortioxetine. Compr Psychiatry. 2019;94:152113. doi:10.1016/j.comppsych.2019.07.006.CrossRefGoogle ScholarPubMed
McIntyre, RS, Lophaven, S, Olsen, CK. A randomized, double-blind, placebo-controlled study of vortioxetine on cognitive function in depressed adults. Int J Neuropsychopharmacol. 2014;17(10):1557–1567. doi:10.1017/S1461145714000546.CrossRefGoogle ScholarPubMed
Jeon, HJ, Walker, RS, Inamori, A, et al. Differences in depressive symptoms between Korean and American outpatients with major depressive disorder. Int Clin Psychopharmacol. 2014;29(3):150–156. doi:10.1097/YIC.0000000000000019.CrossRefGoogle ScholarPubMed
Williams, A, Nakagawa, A, Sado, M, et al. Comparison of initial psychological treatment selections by US and Japanese early-career psychiatrists for patients with major depression: a case vignette study. Acad Psychiatry. 2016;40(2):235–241. doi:10.1007/s40596-015-0398-6.CrossRefGoogle ScholarPubMed
Christensen, MC, Sluth, LB, McIntyre, RS. Validation of the University of California San Diego Performance-based Skills Assessment (UPSA) in major depressive disorder: replication and extension of initial findings. J Affect Disord. 2019;245:508–516. doi:10.1016/j.jad.2018.11.034.CrossRefGoogle Scholar
Cao, B, Zhu, J, Zuckerman, H, et al. Pharmacological interventions targeting anhedonia in patients with major depressive disorder: a systematic review. Progress Neuro-Psychopharmacol Biol Psychiatry. 2019;92:109–117. doi:10.1016/j.pnpbp.2019.01.002.CrossRefGoogle ScholarPubMed
Lu, Y, Ho, CS, McIntyre, RS, Wang, W, Ho, RC. Agomelatine-induced modulation of brain-derived neurotrophic factor (BDNF) in the rat hippocampus. Life Sci. 2018;210:177–184. doi:10.1016/j.lfs.2018.09.003.CrossRefGoogle ScholarPubMed
Hobart, M, Skuban, A, Zhang, P, et al. Efficacy and safety of flexibly dosed brexpiprazole for the adjunctive treatment of major depressive disorder: a randomized, active-referenced, placebo-controlled study. Curr Med Res Opinion. 2018;34(4):633–642. doi:10.1080/03007995.2018.1430220.CrossRefGoogle ScholarPubMed
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