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Antidepressants for major depressive disorder in patients with a co-morbid axis-III disorder: a meta-analysis of patient characteristics and placebo response rates in randomized controlled trials

Iovieno, Nadiaa,b; Tedeschini, Enricoa,c; Ameral, Victoria E.a; Rigatelli, Marcoc; Papakostas, George I.a

International Clinical Psychopharmacology:
doi: 10.1097/YIC.0b013e328340775e

The objective of this study is to assess whether the antidepressants are effective in treating major depressive disorder (MDD) in patients with a co-morbid axis-III disorder, and to compare the relative efficacy (vs. placebo) of antidepressants between these patients and those enrolled in general MDD trials. Medline/Pubmed publication databases were searched. We selected for randomized, double-blind, placebo-controlled trials of antidepressants for MDD, whether conducted in a general population, or in populations with an axis-III disorder. Antidepressants were more effective than placebo in patients with axis-III disorders overall [risk ratio for response (RR)=1.42, P<0.0001], as well as specifically for post-stroke (RR=1.43, P=0.04), human-immunodeficiency virus positive or acquired immunodeficiency syndrome (RR=1.66, P=0.005), but not cancer patients (RR=1.26, P=0.19). There was a trend for higher placebo response rates in studies, which did (41.2%) versus those which did not (37.7%) select for axis-III disorders (P=0.06), and significantly higher antidepressant response rates in studies which did (57.4%) versus those which did not (53.5%) select for axis-III disorders (P=0.01). Antidepressants are effective for MDD in patients who present with co-morbid axis-III disorders and as effective (vs. placebo) in this population as they are in the general MDD population. Higher general response rates observed in the co-morbid MDD population are intriguing, and require replication.

Author Information

aMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

bUniversity of Pisa

cUniversity of Modena and Reggio Emilia, Italy

Correspondence to Dr Enrico Tedeschini, MD, Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 401, Boston, MA 02114, USA Tel: +1 617 513 6821; fax: +1 617 726 7541; e-mail:

Received March 26, 2010

Accepted September 9, 2010

© 2011 Lippincott Williams & Wilkins, Inc.