Antidepressants and Social Functioning in Patients with Major Depressive Disorder: Systematic Review and Meta-Analysis of Double-Blind, Placebo-Controlled RCTs.

INTRODUCTION: Social functioning (SF) is the ability to fulfil one's social obligations and a key outcome in treatment. OBJECTIVE: The aim of the study was to estimate the effects of antidepressants on SF in patients with major depressive disorder (MDD). METHODS: This meta-analysis and its reporting are based on Cochrane Collaboration's Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF). We systematically searched CENTRAL, Medline, PubMed Central, and PsycINFO for double-blind RCTs comparing antidepressants with placebo and reporting on SF. We computed standardized mean differences (SMDs) with 95% CIs and prediction intervals. RESULTS: We selected 40 RCTs out of 1,188 records screened, including 16,586 patients (mean age 46.8 years, 64.2% women). In 27 studies investigating patients with MDD (primary depression), antidepressants resulted in a SMD of 0.25 compared to placebo ([95% CI: 0.21; 0.30] I2: 39%). In 13 trials with patients suffering from MDD comorbid with physical conditions or disorders, the summary estimate was 0.24 ([0.10; 0.37] I2: 75%). In comorbid depression, studies with high/uncertain risk of bias had higher SMDs than low-risk studies: 0.29 [0.13; 0.44] versus 0.04 [-0.16; 0.24]; no such effect was evident in primary depression. There was no indication of sizeable reporting bias. SF efficacy correlated with efficacy on depression scores, Spearman's rho 0.67 (p < 0.001), and QoL, 0.63 (p < 0.001). CONCLUSIONS: The effect of antidepressants on SF is small, similar to its effect on depressive symptoms in primary MDD, and doubtful in comorbid depression. Strong correlations with both antidepressive and QoL effects suggest overlap among domains.

Antidepressants and quality of life in patients with major depressive disorder - Systematic review and meta-analysis of double-blind, placebo-controlled RCTs.

BACKGROUND: Quality of Life (QoL) is an important outcome in mental disorders. We investigated whether antidepressant pharmacotherapy improved QoL vs. placebo among patients with MDD. METHODS: Systematic literature search in CENTRAL, Medline, PubMed Central, and PsycINFO of double-blind, placebo-controlled RCTs. Screening, inclusion, extraction, and risk of bias assessment were conducted independently by two reviewers. We calculated summary standardized mean differences (SMD) with 95%-CIs. We followed Cochrane Collaboration's Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF). RESULTS: We selected 46 RCTs out of 1807 titles and abstracts screened, including 16.171 patients, 9131 on antidepressants and 7040 on placebo, a mean age of 50.9 years, with 64.8% women. Antidepressant drug treatment resulted in a SMD in QoL of 0.22 ([95%-CI: 0.18; 0.26] I2 39%) vs. placebo. SMDs differed by indication: 0.38 ([0.29; 0.46] I2 0%) in maintenance studies, 0.21 ([0.17; 0.25] I2 11%) in acute treatment studies, and 0.11 ([-0.05; 0.26], I2 51%) in studies focussing on patients with a physical condition and major depression. There was no indication of subtstantial small study effects, but 36 RCTs had a high or uncertain risk of bias, particularly maintenance trials. QoL and antidepressive effect sizes were associated (Spearman's rho 0.73, p < 0.001). CONCLUSIONS: Antidepressants' effects on QoL are small in primary MDD, and doubtful in secondary major depression and maintenance trials. The strong correlation of QoL and antidepressive effects indicates that the current practice of measuring QoL may not provide sufficient additional insights into the well-being of patients.

Oesophageal screening during videofluoroscopy: International practices and perspectives of speech-language pathologists.

Purpose: The aim of this study was to investigate international oesophageal screening (OS) practices during videofluoroscopy (VFS) amongst speech-language pathologists (SLPs) and to establish SLP perspectives regarding OS during VFS.Method: A 25-item online survey was developed and disseminated internationally. Respondents were SLPs with dysphagia and VFS experience. Information was sought on OS practices and perspectives. Descriptive statistics were used to analyse results.Result: A total of 202 SLPs completed the survey from USA, UK, Ireland, New Zealand, Australia and Austria. Fifty-eight per cent (n = 117/202) of SLPs internationally include an OS during VFS. This rate varies across USA (81%; 91/113), UK (69%; 18/26) and Ireland (60%; 18/30). Only 25% (29/117) of SLPs use a validated OS protocol. Most SLPs perform an OS in an anterior-posterior view (55%; 64/117) with patients seated (54%; 64/117). Bolus consistencies administered vary greatly. SLPs evaluate oesophageal bolus clearance (81% (95/117), bolus redirection (64%; 75/117), oesophageal transit time (49%; 57/117) and oesophageal pathology (11%; 13/117). Perceived challenges include scope of practice, patient positioning, protocol uncertainty and multidisciplinary support.Conclusion: Over half of SLPs internationally responding to the survey include an OS during VFS. Few follow validated protocols and analysis practices vary. OS guidelines and training opportunities are needed to ensure validated OS protocols are adopted into clinical practice.