Soomro G M, Altman D, Rajagopal S, Oakley-Browne M
St. George's Hospital Medical School, Department of Psychiatry, University of London, Cranmer Terrace, London, UK SW17 0RE.
Cochrane Database Syst Rev. 2008 Jan 23;2008(1):CD001765. doi: 10.1002/14651858.CD001765.pub3.
Obsessive compulsive disorder is a common and disabling disorder. A significant proportion of patients manifest a chronic course. Individual randomised controlled trials (RCTs) have shown that selective serotonin re-uptake inhibitors (SSRIs) are effective in this condition. Previous systematic reviews or meta-analyses summarising the evidence are methodologically problematic or limited in the scope of their analysis.
To examine the efficacy and adverse effects of serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD) in adults.
CCDANCTR-Studies and CCDANCTR-References were searched on 12/11/2007. Reference lists were checked. Experts in the field were contacted.
All RCTs and quasi-RCTs examining the efficacy of SSRIs compared with placebo for OCD in adults were eligible for inclusion.
Selection of studies and data extraction were carried out by two review authors independently, and quality assessment of studies was undertaken. Data analysis was conducted using Review Manager software. Summary measures were produced using the weighted mean difference (WMD) for continuous data and relative risk (RR) for dichotomous data, with 95% confidence intervals (CI). SSRIs were examined as an overall group of drugs, and as individual drugs.
Seventeen studies were included in the review, involving 3097 participants. Based on all 17 studies, SSRIs as a group were more effective than placebo in reducing the symptoms of OCD between 6 and 13 weeks post-treatment, measured using the Yale-Brown Obsessive Compulsive Scale (YBOCS) (WMD -3.21, 95% CI -3.84 to -2.57). The WMD for individual SSRI drugs were similar and not statistically different. Based on 13 studies (2697 participants), SSRIs were more effective than placebo in achieving clinical response at post-treatment (RR 1.84, 95% CI 1.56 to 2.17). The pooled RR was shown to be similar between individual SSRI drugs. Although reported adverse effects data were more limited, with few exceptions, the overall and individual adverse effects for the different SSRIs were always worse than for placebo and, in the majority of cases, the difference was statistically significant. Nausea, headache and insomnia were always reported amongst the most common adverse effects in trials of each of the drugs.
AUTHORS' CONCLUSIONS: SSRIs are more effective than placebo for OCD, at least in the short-term, although there are differences between the adverse effects of individual SSRI drugs. The longer term efficacy and tolerability of different SSRI drugs for OCD has yet to be established.
强迫症是一种常见的致残性疾病。相当一部分患者表现为慢性病程。个别随机对照试验（RCT）表明，选择性5-羟色胺再摄取抑制剂（SSRI）对这种疾病有效。以往总结证据的系统评价或荟萃分析在方法上存在问题，或分析范围有限。
探讨5-羟色胺再摄取抑制剂（SSRI）与安慰剂相比，对成人强迫症（OCD）的疗效及不良反应。
于2007年11月12日检索了Cochrane对照试验中心注册库（Cochrane Central Register of Controlled Trials, CCDANCTR）-研究和Cochrane对照试验中心注册库-参考文献。检查了参考文献列表，并联系了该领域的专家。
所有比较SSRI与安慰剂对成人OCD疗效的RCT和半随机对照试验均符合纳入标准。
由两位综述作者独立进行研究选择和数据提取，并对研究进行质量评估。使用Review Manager软件进行数据分析。连续数据采用加权均数差（WMD），二分数据采用相对危险度（RR）生成汇总测量值，并给出95%置信区间（CI）。将SSRI作为一组药物进行检查，并作为单一药物进行检查。
本综述纳入了17项研究，涉及3097名参与者。基于所有17项研究，在治疗后6至13周，使用耶鲁-布朗强迫症量表（YBOCS）测量，作为一组的SSRI比安慰剂在减轻OCD症状方面更有效（WMD -3.21，95%CI -3.84至-2.57）。单一SSRI药物的WMD相似，无统计学差异。基于13项研究（2697名参与者），SSRI在治疗后实现临床缓解方面比安慰剂更有效（RR 1.84，95%CI 1.56至2.17）。各单一SSRI药物的合并RR相似。尽管报告的不良反应数据较为有限，但除少数例外，不同SSRI的总体和个体不良反应总是比安慰剂更严重，且在大多数情况下，差异具有统计学意义。恶心、头痛和失眠在每种药物的试验中总是报告为最常见的不良反应。
SSRI对OCD比安慰剂更有效，至少在短期内如此，尽管各单一SSRI药物的不良反应存在差异。不同SSRI药物对OCD的长期疗效和耐受性尚未确定。
