Question: In adults with agitated depression (or severe agitated or anxious features comorbid to depression), which intervention is most effective, compared to treatment as usual, in reducing symptoms of agitation and depression?

Answer:

Evidence from a meta-analysis of eight randomised controlled trials (RCTs) indicated that mirtazapine is superior to placebo and similar to amitriptyline for reducing symptoms of anxiety in people with moderate to severe depression. Two additional RCTs provided data indicating that the selective serotonin reuptake inhibitors fluoxetine, sertraline, and paroxetine are similarly effective in treating people with major depression and anxiety and that fluoxetine is similarly effective to amitriptyline; the majority of participants in both of these trails had experienced recurrent episodes of major depression. All studies in this evidence summary reported results which indicated improvements in symptoms of anxiety following treatment with antidepressant medication. These results are likely to be reliable, but further RCTs would be useful to explore the effectiveness of other pharmacological and non-pharmacological therapeutic options.