Study designs of evaluations included in the review
No inclusion criteria relating to study design were reported. Randomised controlled trials (RCTs), uncontrolled before-and-after studies (including one study where participants were followed up a year later), and case studies (including one study where participants were followed up 2.5 years later) were included.
Specific interventions included in the review
Antiglucorticoids. Studies of antiglucorticoids were eligible for inclusion. The cortisol-lowering agents included aminoglutethimide (750 to 1,000 mg/day), metyrapone (200 to 2,000 mg/day) and ketoconazole (200 to 1,200 mg/day).
Participants included in the review
Depression. Studies of patients with primary or idiopathic depression were eligible for inclusion. People with major depressive disorder (MDD) included those with bipolar disorder, chronic atypical depression, psychotic features and treatment-resistant and treatment-refractory MDD. Some patients appear to have been identified as hypercortisolaemic.
Outcomes assessed in the review
No inclusion criteria relating to the outcomes were reported. Reductions in depression and/or improvements in mood were assessed on the basis of the following: remission of symptoms; subjective improvement; 50% reduction in scores on the Hamilton Rating Scale for Depression (HSRD); final score of less than or equal to 15 on the HSRD; reductions in the Montgomery-Asberg Depression Rating Scale; reduction in cortisol levels; reduction in total 11-deoxycortisol; reduction in serum DHEA levels; or reduction in antidepressant response.
How were decisions on the relevance of primary studies made?
The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection.