Few studies have analyzed treatments for depression and anxiety in adults with RA, and the level of evidence that currently exists is low to moderate due to the risk for bias and the small number of trials, according to findings published in the Journal of Clinical Rheumatology.
“Because the peak age at onset is in the fourth and fifth decades of life, RA affects individuals in the prime of their lives from social and work perspectives and is associated with considerable disability,” Kirsten M. Fiest, PhD, of the University of Manitoba, in Winnipeg, Canada, and colleagues wrote. “Depression will affect up to 66% and anxiety up to 70% of individuals with RA, and almost 17% of persons with RA have a current major depressive disorder. In persons with RA, depression is associated with higher levels of pain and disability, lower health-related quality of life and increased mortality.”
To conduct their literature review of controlled trials of depression and anxiety treatments among patients with RA, the researchers searched multiple online databases from inception to March 25, 2015, without restrictions on language, date or publication location. They included controlled trials of persons with both RA and depression or anxiety.
In addition, two independent reviewers extracted information including trial and participant characteristics. The researchers pooled standardized mean differences (SMDs) of depression or anxiety scores at postassessment between treatment and comparison groups, stratified by active vs. inactive comparators, they said.
According to the researchers, among 1,291 unique abstracts, they recorded eight trials of depression treatment in patients with RA, including six pharmacological studies, one psychological and one that included both intervention. Pharmacological depression treatments with inactive comparators — recorded in three trials, with 143 participants — did not reduce depressive symptoms (SMD = 0.21; 95% CI, 1.27 to 0.85). Meanwhile, treatments with active comparators — recorded in three trials, with 190 participants — did improve depressive symptoms (SMD = 0.79; 95% CI, 1.34 to 0.25), the researchers found. The single psychological trial of depression treatment in patients with RA did not improve depressive symptoms (SMD, 0.44; 95% CI, 0.96 to 0.08). In addition, seven of the trials had an unclear risk for bias.
“Our findings highlight paucity of information to support clinicians treating depression and anxiety in RA and underscore the urgent need for further intervention trials in the area of psychiatric comorbidity in RA to inform clinical care,” Fiest and colleagues wrote. “Furthermore, as depression and anxiety are chronic health conditions, it is important for future trials to be conducted with extended follow-up periods to determine effectiveness over the long term.” – by Jason Laday
Disclosure: The researchers report funding from the Canadian Institutes of Health Research, the MS Society of Canada, the Bingham Chair in Gastroenterology and Research Manitoba.