Maneeton N, Srisurapanont M
Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand.
J Med Assoc Thai. 2000 Nov;83(11):1367-74.
The tricyclic antidepressants (TCAs) are effective for the treatment of adult depression. However, their efficacy of these in the treatment of children and adolescents with depression is equivocal. Therefore, it is necessary to determine the efficacy and acceptability of TCAs in the treatment of depressive disorders in children and adolescents. The databases of MEDLINE (from 1966 to October 1999) and Controlled Clinical Trials Registered (from 1980 to October 1999) were searched for randomized-controlled trials relevant to the use of TCAs for treating depressed children and adolescents. The reviewers also examined the reference lists of identified papers and that of a previous meta-analysis. In each trial, both nonresponse rates and dropout rates were taken into account and extracted on an intention-to-treat basis. The nonresponse-rate and dropout-rate odd ratios (ORs) with 95 per cent confidence intervals (95% CIs) of each trial and the pooled non-response-rate and dropout-rate ORs (95% CIs) of all trials were computed. Nine trials included in this meta-analysis were 2 amitriptyline, 3 desipramine, 2 imipramine, and 2 nortriptyline studies. By using a fixed-effect model, the pooled nonresponse-rate OR (95% CI) and the pooled dropout rate OR (95% CI) of antidepressant-treated group were 0.92 (0.57 to 1.47) and 2.14 (1.12 to 4.09), respectively. In summary, the evidence so far does not support that TCAs are more effective or more acceptable than placebo in the treatment of depressive disorders in children and adolescents. However, the studies of selective serotonin reuptake inhibitors and newer antidepressants for the treatment of these disorders should be further investigated.
三环类抗抑郁药（TCAs）对成人抑郁症的治疗有效。然而，它们在治疗儿童和青少年抑郁症方面的疗效并不明确。因此，有必要确定TCAs在治疗儿童和青少年抑郁症方面的疗效和可接受性。检索了MEDLINE数据库（1966年至1999年10月）和对照临床试验注册数据库（1980年至1999年10月），以查找与使用TCAs治疗抑郁儿童和青少年相关的随机对照试验。综述作者还查阅了已确定论文的参考文献列表以及先前一项荟萃分析的参考文献列表。在每项试验中，均考虑了无反应率和退出率，并基于意向性治疗原则进行提取。计算了每项试验的无反应率和退出率优势比（ORs）及其95%置信区间（95% CIs），以及所有试验合并的无反应率和退出率ORs（95% CIs）。该荟萃分析纳入的9项试验中，有2项是关于阿米替林的研究，3项是关于地昔帕明的研究，2项是关于丙咪嗪的研究，2项是关于去甲替林的研究。采用固定效应模型，抗抑郁药治疗组的合并无反应率OR（95% CI）和合并退出率OR（95% CI）分别为0.92（0.57至1.47）和2.14（1.12至4.09）。总之，目前的证据并不支持在治疗儿童和青少年抑郁症方面，TCAs比安慰剂更有效或更可接受。然而，对于选择性5-羟色胺再摄取抑制剂和新型抗抑郁药治疗这些疾病的研究应进一步开展。
