Department and Institute of Psychiatry, University of Sao Paulo, Brazil;
Ther Clin Risk Manag. 2009;5:897-910. doi: 10.2147/tcrm.s5751. Epub 2009 Nov 18.
Use of antidepressants is the gold standard therapy for major depression. However, despite the large number of commercially available antidepressant drugs there are several differences among them in efficacy, tolerability, and cost-effectiveness. In addition the optimal augmentation strategy is still not clear when dealing with treatment-resistant depression, a condition that affects 15% to 40% of depressed patients.
We therefore reviewed the main characteristics of these drugs regarding their efficacy, tolerability, side effects and cost-effectiveness, by accessing all meta-analyses and systematic reviews published from 2004 to 2009. In addition, we reviewed the augmentation strategy of associated antidepressants with neurostimulation therapies (such as transcranial magnetic stimulation [TMS] and transcranial direct current stimulation [tDCS]). A search was undertaken in MEDLINE, Web of Science, Cochrane, and Scielo databases. We included: 21 meta-analyses of antidepressant trials, 15 neurostimulation clinical trials and 8 studies of pharmacoeconomics. We then performed a comprehensive review on these articles.
Although recent meta-analyses suggest sertraline and escitalopram might have increased efficacy/tolerability, other studies and large pragmatic trials have not found these to be superior to other antidepressant drugs. Also, we did not identify any superior drug in terms of cost-effectiveness due to the different designs observed among pharmacoecomics studies. Side effects such as sexual dysfunction, gastrointestinal problems and weight gain were common causes of discontinuation. Tolerability was an important issue for novel neurostimulation interventions, such as TMS and tDCS. These therapies might be interesting augmentation strategies, considering their benign profile of side effects, if proper safety parameters are adopted.
抗抑郁药的使用是治疗重度抑郁症的金标准疗法。然而，尽管有大量的商业上可用的抗抑郁药物，但它们在疗效、耐受性和成本效益方面存在着几个差异。此外，在处理治疗抵抗性抑郁症时，最佳的增强策略仍然不清楚，这种情况影响了 15%到 40%的抑郁患者。
因此，我们通过查阅 2004 年至 2009 年发表的所有荟萃分析和系统评价，审查了这些药物在疗效、耐受性、副作用和成本效益方面的主要特征。此外，我们还回顾了与神经刺激疗法（如经颅磁刺激[TMS]和经颅直流电刺激[tDCS]）相关的抗抑郁药物的增强策略。我们在 MEDLINE、Web of Science、Cochrane 和 Scielo 数据库中进行了检索。我们包括：21 项抗抑郁试验的荟萃分析、15 项神经刺激临床试验和 8 项药物经济学研究。然后，我们对这些文章进行了全面的综述。
尽管最近的荟萃分析表明舍曲林和依地普仑可能具有更高的疗效/耐受性，但其他研究和大型实用试验并没有发现它们比其他抗抑郁药物更优越。此外，由于药物经济学研究中观察到的不同设计，我们没有发现任何在成本效益方面具有优势的药物。副作用如性功能障碍、胃肠道问题和体重增加是导致停药的常见原因。耐受性是新型神经刺激干预的一个重要问题，如 TMS 和 tDCS。如果采用适当的安全参数，这些治疗方法可能是有趣的增强策略，因为它们的副作用谱良性。
