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Antidepressant plus benzodiazepine for major depression.
T A Furukawa1, D L Streiner, L T Young
1Department of Psychiatry, Nagoya City University Medical School, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan, 467-8601. furukawa@med.nagoya-cu.ac.jp
The Cochrane Database of Systematic Reviews
|June 19, 2001
Summary
Adding benzodiazepines to antidepressants may improve depression symptoms short-term and reduce dropout rates. However, long-term benefits and risks like dependence require careful consideration.
Area of Science:
- Psychiatry and Clinical Psychology
- Pharmacology and Therapeutics
Background:
- Anxiety and depression frequently co-occur, leading to the common practice of combining antidepressants with benzodiazepines.
- Evidence supporting the superior efficacy of this combination over antidepressants alone is limited, with concerns regarding long-term effectiveness and dependence risks.
Purpose of the Study:
- To evaluate the short-term (less than 8 weeks) and long-term (more than 2 months) efficacy and safety of adding benzodiazepines to antidepressants for major depression.
- To compare outcomes of combined treatment versus antidepressant monotherapy in adult patients with major depressive disorder.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing combined antidepressant-benzodiazepine treatment with antidepressant monotherapy.
- Extensive literature search across multiple databases (MEDLINE, EMBASE, PsycLIT, etc.) up to September 1997, supplemented by hand and reference searching.
- Data extraction and quality assessment by two independent reviewers, with outcomes analyzed using random-effects models.
Main Results:
- The combination therapy group showed significantly lower dropout rates compared to the antidepressant-alone group (RR 0.63).
- Intention-to-treat analyses indicated greater improvement in depression symptoms at 1 and 4 weeks for the combination group (RR 1.63 and 1.38, respectively).
- No significant difference in depression improvement was observed at 6-8 weeks, and dropout rates due to side effects were lower in the combination group (RR 0.53), though overall side effect incidence was similar.
Conclusions:
- Adding benzodiazepines to antidepressants may offer short-term benefits in symptom improvement and reduced dropout rates for major depression.
- The potential advantages must be weighed against risks such as dependence, accident proneness, and the possibility of continued suffering from non-response or dropout.
- The limited duration of included trials (max 8 weeks) precludes definitive conclusions on long-term efficacy and safety.