Hansen Richard, Gaynes Bradley, Thieda Patricia, Gartlehner Gerald, Deveaugh-Geiss Angela, Krebs Erin, Lohr Kathleen
Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA.
Psychiatr Serv. 2008 Oct;59(10):1121-30. doi: 10.1176/ps.2008.59.10.1121.
This meta-analysis reviewed data on the efficacy and effectiveness of second-generation antidepressants for preventing major depression relapse and recurrence during continuation and maintenance phases of treatment, respectively.
MEDLINE, EMBASE, and PsycINFO, the Cochrane Library, and International Pharmaceutical Abstracts were searched for the period of January 1980 through April 2007 for reviews, randomized controlled trials, meta-analyses, and observational studies on the topic. Two persons independently reviewed abstracts and full-text articles using a structured data abstraction form to ensure consistency in appraisal and data extraction.
Four comparative trials and 23 placebo-controlled trials that addressed relapse or recurrence prevention were included. Results of comparative trials have not demonstrated statistically significant differences between duloxetine and paroxetine, fluoxetine and sertraline, fluvoxamine and sertraline, and trazodone and venlafaxine. Pooled data for the class of second-generation antidepressants compared with placebo suggested a relatively large effect size that persists over time. For preventing both relapse and recurrence, the number of patients needed to treat is five (95% confidence interval of 4 to 6). Differences in the length of open-label treatment before randomization, drug type, and trial duration did not affect pooled estimates of relapse rates. Across all trials, 7% of patients randomly assigned to receive active treatment and 5% of patients randomly assigned to receive a placebo discontinued treatment because of adverse events.
This review demonstrates the overall benefits of continuation- and maintenance-phase treatment of major depression with second-generation antidepressants and emphasizes the need for additional studies of comparative differences among drugs.
本荟萃分析分别回顾了关于第二代抗抑郁药在治疗的延续期和维持期预防重度抑郁症复发和再发的疗效和有效性的数据。
检索MEDLINE、EMBASE、PsycINFO、Cochrane图书馆和国际药学文摘，检索时间为1980年1月至2007年4月，查找关于该主题的综述、随机对照试验、荟萃分析和观察性研究。两人使用结构化数据提取表独立审查摘要和全文文章，以确保评估和数据提取的一致性。
纳入了四项比较试验和23项针对复发或再发预防的安慰剂对照试验。比较试验的结果未显示度洛西汀与帕罗西汀、氟西汀与舍曲林、氟伏沙明与舍曲林以及曲唑酮与文拉法辛之间存在统计学上的显著差异。与安慰剂相比，第二代抗抑郁药类别的汇总数据显示出相对较大的效应量，且随时间持续存在。为预防复发和再发，所需治疗的患者人数为5人（95%置信区间为4至6）。随机分组前开放标签治疗的时长、药物类型和试验持续时间的差异并未影响复发率的汇总估计。在所有试验中，随机分配接受活性治疗的患者中有7%因不良事件停药，随机分配接受安慰剂的患者中有5%因不良事件停药。
本综述证明了使用第二代抗抑郁药进行重度抑郁症延续期和维持期治疗的总体益处，并强调需要对药物之间的比较差异进行更多研究。
