Did the studies included use continuous or discrete data for their primary efficacy endpoint?
What is continuous
100
What is HAMD?
What is the Hamilton Rating Scale for Depression - used to assess depression severity
100
What was the sample size of the study?
What is 8331 participants across 29 studies.
100
What acceptability endpoint should they have specifically expanded on?
Withdrawal from treatment - it would have been useful to understand what reasons individuals had for leaving the study, in order to assess specifics of tolerability (e.g. weight gain, somnolence)
100
The secondary acceptability endpoint
What is withdrawal from treatment for any reason
200
What types of depressive populations were excluded?
What is unipolar depression, mixtures of unipolar/bipolar depression, and refractory bipolar depression
200
What is Hedge's G?
What is a measurement of effect size, calculation of standard mean difference
200
This study lumped drugs into categories based on their chemical/pharmacological similarities. Why is this a good thing?
Because looking at too many interventions weakens the strength of analysis.
200
Meta analyses look at both direct and indirect comparisons, what is a weakness of this method?
They do not put more weight on head-to-head trials (direct comparisons) over indirect comparisons.
200
The secondary efficacy endpoint
What is likelihood of response
300
What validated depression scales were included?
What is HAM-D and MADRS
300
What does SUCRA stand for?
What is surface under the cumulative ranking curve
300
How did the study account for the generalization of drugs into these categories?
They examined the validity of the groupings by comparing treatment effect estimates within drug class for each direct comparison available.
300
This study did not account for "background drugs" such as mood stabilizers and benzodiazepines patients were on prior to admission - why is this a weakness?
There is a potential for additive or synergistic effects with the trial medications, could bias the results.
300
How was response defined?
What is as 50% reduction in the depression scale rating
400
What ages were excluded
What is <18 years of age
400
What is MADRS?
What is the Montgomery Asberg Depression Rating Scale - used to assess depression severity
400
Did this study look for statistical heterogeneity? If so, what tool did they use? If not, why?
Yes they did, they used the chi squared statistic. They also looked at inclusion/exclusion criteria for similarities.
400
Why is it bad that some studies had smaller patient populations than others?
Gives decreased precision, therefore decreases the ability to properly distinguish between treatments.
400
Primary acceptability endpoint
What is the lack of switch to mania
500
What length of studies were included?
What is 4-16 weeks
500
What does the Cochrane Tool measure?
What is risk of bias
500
How strong is the external validity to our patient?
Studies looked at adults with a current bipolar depressive episode, with no mixed/hypomanic state - this is what Taylor is experiencing.
500
What would be the benefit of extending the duration of the studies?
Would allow more time to measure improvement, as well as time to distinguish if improvement was actually decrease in depression or a progressive switch to mania