Antiglucocorticoid treatments for mood disorders

P. Gallagher, Navdeep Malik, J. Newham, Allan H. Young, I Nicol Ferrier, Paul Mackin

Research output: Contribution to journalArticlepeer-review

62 Citations (Scopus)

Abstract

Background
Antiglucocorticoids may have antidepressant effects and have been reported to be efficacious in the treatment of severe psychiatric disorders. The efficacy and safety of antiglucocorticoid treatments for mood disorders is the subject of this systematic review.

Objectives
To compare the efficacy and safety of antiglucocorticoid agents in the treatment of mood episodes (manic, mixed affective or depressive) with placebo or alternative drug treatment in mood disorders.

Search methods
CCDANCTR‐Studies and CCDANCTR‐References were searched on 11‐9‐2007. Additional searches of electronic databases were conducted in December 2006. Conference proceedings were searched. Experts and pharmaceutical companies were contacted.

Selection criteria
Randomised controlled trials comparing antiglucocorticoid drugs in the treatment of mood episodes with placebo or alternative drug treatment in mood disorders were selected.

Data collection and analysis
Data were extracted and the methodological quality of each study was assessed independently by two review authors. Meta‐analyses were performed using Review Manager software. Relative risk (RR) with 95% confidence intervals (CI) were calculated for dichotomous outcomes. For continuous data, weighted mean differences (WMD) were calculated.

Main results
Nine studies met criteria for inclusion. A number of drugs were examined, including mifepristone [RU‐486], ketoconazole, metyrapone and DHEA. Three trials were in patients with psychotic major depression (pMDD), five trials in non‐psychotic major depression and one trial in bipolar disorder. When examining all trials together across all affective episodes, there was no significant difference in the overall proportion of patients responding to antiglucocorticoid treatment over placebo, although the mean change in HAM‐D scores indicated a significant difference in favour of treatment (WMD ‐4.54, 95%CI ‐6.78 to ‐2.29). Of the five trials in non‐psychotic depression (unipolar or bipolar), there was a significant difference favouring treatment (HAM‐D 50% reduction: RR 0.72, 95%CI 0.56 to 0.91). In pMDD, there was no evidence of an overall antidepressant effect (HAM‐D 50% reduction: RR 0.98, 95%CI 0.79 to 1.22) or an effect on overall psychopathology (BPRS 30% reduction: RR 0.96, 95%CI 0.76 to 1.22). In these subtypes, the mean change in HAM‐D indicated a significant difference in favour of treatment.

Authors' conclusions
The use of antiglucocorticoids in the treatment of mood disorders is at the proof‐of‐concept stage. Considerable methodological differences exist between studies with respect to the compounds used and the patient cohorts studied. Results in some diagnostic subtypes are promising and warrant further investigation to establish the clinical utility of these drugs in the treatment of mood disorders.
Original languageEnglish
Number of pages77
JournalCochrane Database of Systematic Reviews
Issue number1
DOIs
Publication statusPublished - 23 Jan 2008
Externally publishedYes

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