Depression: Antidepressants beneficial in physically ill patients

One of the most neglected areas of healthcare research is the effects of physical illness on an individual's mental health. Research suggests that more than ten percent of patients suffering from physical diseases also suffer from depression. For reasons that are not entirely clear, depression may amplify the symptoms of physical disease and increase the risk of these patients dying. Studies suggest that doctors are less likely to prescribe antidepressants to people who are physically ill because they are unsure if they are helpful for these patients. Therefore, it is important to know whether antidepressants can be effective in people with physical illness.

The review included 51 studies comparing antidepressants to placebos. Most studies trialled selective serotonin reuptake inhibitors or tricyclic antidepressants. A total of 3603 patients were involved, suffering from physical illnesses including stroke, HIV/AIDS, Parkinson's disease and cancer. The researchers found that antidepressants were more effective than placebos, although patients receiving antidepressants were more likely to experience adverse effects, including sexual dysfunction and dry mouth. For every six people receiving treatment, one more could be expected to benefit at between six and eight weeks if they were taking antidepressants.

Lead author Lauren Rayner of King's College London said, "Although trials were small, they do seem to indicate a genuine benefit associated with antidepressants. However, patients with more severe physical illness and more severely depressed patients were not included in the trials. It is possible that those with more severe illness don't respond so well to treatment with antidepressants. This is something that should be addressed in further studies."

Senior investigator Professor Matthew Hotopf, Institute of Psychiatry, King's College London added: "As a clinician I see many patients struggling with the effects of physical disease on their mental health. Doctors should take into account patients' preferences, symptoms and possible interactions with any other medications they are taking when prescribing antidepressants to physically ill patients." He concludes: "This is a critical area of research which will help doctors maximise a patient's treatment and recovery from the mental and physical symptoms of illness."

"This research is very important for millions of patients and families who are experiencing physical illness, including the most advanced stages of disease," said Professor Irene Higginson, senior investigator and Head of the Cicely Saunders Institute, King's College London. "Until now many doctors and nurses were worried that these treatments did not work well in people with physical illness. This result shows that they are usually of benefit. Already we are using the results to inform a new European Guideline for doctors and nurses on the management of depression."