Depression is one of the leading causes of the global burden of disease, and it has particularly negative consequences for elderly patients. Antidepressants are the most frequently used treatment. We present the first single-group meta-analysis examining: 1) the response rates of elderly patients to antidepressants, and 2) the determinants of antidepressants response in this population. We searched multiple databases for randomized controlled trials on antidepressants in the elderly with major depressive disorder above 65 years (last search: December 2017). Response was defined as 50% improvement on validated rating scales. We extracted response rates from studies and imputed the missing ones with a validated method. Data were pooled in a single-group meta-analysis. Additionally, several potential moderators of response to antidepressants were examined by subgroup and meta-regression analyses. We included 44 studies with a total of 6373 participants receiving antidepressants. On average, 50.7% of the patients reached a reduction of at least 50% on the Hamilton Depression Scale (HAMD). Subgroup and meta-regression analyses revealed a better response to treatment for patients in antidepressant-controlled trials compared to placebo-controlled trials. Mean age, study duration, percentage of woman, severity of illness at baseline, dose of antidepressants in fluoxetine equivalents, year of publication, setting (in- or out-patients), antidepressant groups (SSRI, TCA, SSNRI, α2-antagonist, SNRI, MAO-inhibitor), ITT (intention-to-treat) analysis vs completer analysis, sponsorship and overall risk of bias were not significant moderators of response. Our findings suggest an improvement in symptoms can be found in about 50% of the elderly with major depressive disorder treated with antidepressants.

中文翻译：

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患有重度抑郁症的老年患者对抗抑郁药的反应如何：系统评价和单组荟萃分析。

抑郁症是造成全球疾病负担的主要原因之一，对老年患者尤其不利。抗抑郁药是最常用的治疗方法。我们提出了第一个单组荟萃分析，以检查：1）老年患者对抗抑郁药的反应率，以及2）该人群中抗抑郁药反应的决定因素。我们在多个数据库中搜索了65岁以上重度抑郁症老年人的抗抑郁药的随机对照试验（最新搜索：2017年12月）。响应定义为在经过验证的等级量表上提高50％。我们从研究中提取了回应率，并使用一种经过验证的方法估算了缺失的人。数据汇总在单组荟萃分析中。另外，通过亚组和荟萃回归分析研究了抗抑郁药应答的几种潜在调节剂。我们纳入了44项研究，共有6373名参与者接受了抗抑郁药治疗。平均而言，汉密尔顿抑郁量表（HAMD）减少了50.7％的患者至少减少了50％。亚组和荟萃回归分析显示，与安慰剂对照试验相比，抗抑郁药对照试验对患者的治疗反应更好。平均年龄，研究时间，女性百分比，基线时的疾病严重程度，氟西汀当量中抗抑郁药的剂量，出版年份，背景（住院或门诊患者），抗抑郁药组（SSRI，TCA，SSNRI，α2拮抗剂， SNRI，MAO抑制剂），ITT（意图治疗）分析与完成剂分析，赞助和总体偏见风险不是反应的重要调节剂。我们的研究结果表明，在约有50％的患有重度抑郁症的老年人中，使用抗抑郁药治疗后，症状会有所改善。