DULOXETINE FOR DEPRESSION IN ATHLETES: A META-ANALYSIS OF ITS EFFICACY AND IMPLICATIONS FOR MENTAL HEALTH MANAGEMENT

Abstract

Background: Major depressive disorder (MDD) is a prevalent mental health issue in the general population and poses unique challenges within the athletic community, where the pressures of performance and physical strain can exacerbate or mask symptoms. This meta-analysis aimed to evaluate the efficacy and tolerance of duloxetine in treating MDD, with a specific focus on its application for athletes experiencing depression and its potential impact on both mental and physical health. Methods: Searches were conducted in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to August 2021, focusing on trials comparing duloxetine to placebo and other second-generation antidepressants. The outcomes were expressed as risk ratios (RR) or standardized mean differences (SMD) with 95% confidence intervals (CIs), utilizing a random-effects model for combined estimates. Results: Our analysis included 13 studies encompassing 5597 participants, revealing that duloxetine was more effective than placebo in managing depressive symptoms in nine studies (SMD -0.33, 95% CI -0.41 to 0.24; P <0.001; 9 studies, 3106 participants). However, its efficacy was comparable to other antidepressants (SMD -0.05, 95% CI -0.15 to 0.05; P=0.32; 8 studies, 2491 participants). Notably, against anxiety symptoms associated with MDD, duloxetine's superiority was not established compared to other antidepressants (SMD -0.26, 95% CI -1.08 to 0.55; P=0.53; 2 studies, 809 participants). Conclusions: The findings suggest duloxetine's potential benefits in treating depression in athletes, given its efficacy over placebo. However, its comparable performance to other antidepressants and unclear advantage for comorbid anxiety symptoms highlight the need for further investigation. This research underscores the importance of personalized treatment strategies in managing athlete mental health, advocating for more targeted studies to optimize therapeutic outcomes in this unique population.