Lancet:21种抗抑郁药对成人重度抑郁疗效及耐受性比较研究

2018-02-22 zhangfan MedSci原创

研究认为21种常见抗抑郁药物对于成年严重抑郁的治疗效果均优于安慰剂,但治疗耐受性差异显著。该研究为病人、医生、指南制定人员和决策者临床实践和治疗指南制定提供了可靠的依据

抑郁是全世界成年人最常见、负担沉重和代价高昂的精神疾病之一。抑郁的治疗包含药物或非药物手段(心理治疗)。近日研究人员开展系统综述和荟萃分析考察不同抗抑郁药物对成年单极性抑郁的治疗效果。

研究人员对截止2016年1月8日Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO等相关临床及学术网站的研究进行收集 ,比较21种成年抗抑郁药物对重度抑郁的治疗效果。研究的主要终点为有效性(治疗响应)和耐受性(任何因素导致的治疗中断)。

研究汇总28552篇相关研究,包含522个临床试验以及116477名参与者。在疗效方面,所有药物的抗抑郁效果均优于安慰剂,其比值比范围由瑞波西汀的1.37到阿密曲替林的2.13。耐受性方面,仅阿戈美拉汀(OR 0.84)和氟西汀(0.88)的中断率低于安慰剂,氯丙咪嗪的中断率高于安慰剂(1.30)。所有研究中,不同抗抑郁药物的有效性比值比范围为1.15-1.55,耐受性范围为0.64-0.83;在头碰头研究中阿莫美拉汀,阿米替林,依司他普兰,米氮平,帕罗西汀,文拉法辛和伏蒂奥辛的疗效高于对照药物,而氟西汀、氟伏沙明、雷博西汀和曲唑酮的疗效低于对照药物(0.51-0.84);可接受性方面,阿戈米拉汀,西酞普兰,埃西他普兰,氟西汀,舍曲林和伏蒂奥西汀的耐受性高于对照药物(0.43-0.77),而阿米替林,氯丙咪嗪,度洛西汀,氟伏沙明,雷博西汀,曲唑酮和文拉法辛中断率最高(1.30-2.32)。522个研究中,46个研究(9%)具有较高的偏倚,380个研究偏倚中等(73%),96个研究偏倚性低(18%),证据质量中等到极低。

研究认为21种常见抗抑郁药物对于成年严重抑郁的治疗效果均优于安慰剂,但治疗耐受性差异显著。该研究为病人、医生、指南制定人员和决策者临床实践和治疗指南制定提供了可靠的依据。

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    2018-07-13 howi
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    2019-01-17 wetgdt
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    2018-03-01 135****7952平儿

    学了........

    0

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    2018-02-28 135****7952平儿

    学了......

    0

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    2018-02-24 liuyichuan1990

    错别字比较多

    0

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