Chen Yan, Guo Jeff J, Zhan Siyan, Patel Nick C
Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy Practice and Administrative Sciences, School of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH 45267-0004, USA.
Ann Pharmacother. 2006 Dec;40(12):2115-22. doi: 10.1345/aph.1H389. Epub 2006 Nov 21.
Appropriate treatment of post-stroke depression (PSD) is critically important, considering the negative impact of PSD. Data regarding the treatment efficacy of antidepressants in patients with PSD are conflicting, and the time-dependent effects of antidepressant treatment in this population are unknown.
To systematically assess treatment effects of antidepressants in patients with PSD, incorporating data from recent studies.
A meta-analysis of randomized placebo-controlled trials (RCTs) of antidepressants in patients with PSD was conducted, using published studies from 1984 to 2006. Outcome measures of antidepressant treatment included response rate, depression rating scale scores, recovery of neurologic impairments, and improvements in activities of daily living (ADLs) after stroke. The effect size was presented as rate difference (RD) and weighted mean difference for dichotomous outcomes and continuous outcomes, respectively. Pooled effect sizes were calculated by both fixed-effects and random-effects models.
A total of 1320 patients who met inclusion criteria were identified from 16 RCTs. The pooled response rates in the active and placebo groups were 65.18% (234/359) and 44.37% (138/311), respectively. The pooled RD was 0.23 (95% CI 0.03 to 0.43), indicating a significantly higher response rate in the active group compared with the placebo group. From baseline to endpoint, patients in the active group had significantly greater improvement in depressive symptoms compared with patients in the placebo group. Longer duration of treatment was positively correlated with the degree of improvement in depressive symptoms (Spearman's correlation, [rho] = -0.93, p = 0.001). No consistent evidence was found for positive antidepressant effects on the recovery of neurologic impairments and improvements in ADLs.
The results of this meta-analysis suggest that use of antidepressants among patients with a diagnosis of PSD is associated with improvement in depressive symptoms. Longer durations of antidepressant treatment may be associated with greater reductions in depressive symptoms.
考虑到卒中后抑郁（PSD）的负面影响，对其进行适当治疗至关重要。关于抗抑郁药对PSD患者治疗效果的数据存在冲突，且抗抑郁治疗在该人群中的时间依赖性效应尚不清楚。
纳入近期研究数据，系统评估抗抑郁药对PSD患者的治疗效果。
对1984年至2006年发表的关于抗抑郁药治疗PSD患者的随机安慰剂对照试验（RCT）进行荟萃分析。抗抑郁治疗的结局指标包括缓解率、抑郁评定量表评分、神经功能缺损的恢复情况以及卒中后日常生活活动（ADL）的改善情况。效应量分别以率差（RD）和加权均数差表示，用于二分结局和连续结局。采用固定效应模型和随机效应模型计算合并效应量。
从16项RCT中确定了1320例符合纳入标准的患者。治疗组和安慰剂组的合并缓解率分别为65.18%（234/359）和44.37%（138/311）。合并RD为0.23（95%CI 0.03至0.43），表明治疗组的缓解率显著高于安慰剂组。从基线到终点，治疗组患者的抑郁症状改善程度显著大于安慰剂组患者。治疗持续时间越长，抑郁症状改善程度越高（Spearman相关系数，[rho]= -0.93，p = 0.001）。未发现抗抑郁药对神经功能缺损恢复和ADL改善有一致的积极作用的证据。
该荟萃分析结果表明，诊断为PSD的患者使用抗抑郁药可改善抑郁症状。抗抑郁治疗时间越长，抑郁症状减轻可能越明显。
