Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Gen Pract. 2010 Jun;16(2):106-12. doi: 10.3109/13814781003692463.
Long-term treatment with antidepressants is considered effective in preventing recurrence of major depressive disorder (MDD). It is unclear whether this is true for primary care.
We investigated whether current guideline recommendations for long-term treatment with antidepressants in primary care are supported by evidence from primary care.
Data sources for studies on antidepressants: PubMed, Cochrane Library, Embase, PsycInfo, Cinahl, articles from reference lists, cited reference search.
adults in primary care, continuation or maintenance treatment with antidepressants, with outcome relapse or recurrence, (randomized controlled) trial/naturalistic study/review.
published before October 2009 in English.
Thirteen depression guidelines were collected. These guidelines recommend continuation treatment with antidepressants after remission for all patients including patients from primary care, and maintenance treatment for those at high risk of recurrence. Recommendations vary for duration of treatment and definitions of high risk. We screened 804 literature records (title, abstract), and considered 27 full-text articles. Only two studies performed in primary care addressed the efficacy of antidepressants in the long-term treatment of recurrent MDD. A double-blind RCT comparing mirtazapine (n = 99) and paroxetine (n = 98) prescribed for 24 weeks reported that in both groups 2 patients relapsed. An open study of 1031 patients receiving sertraline for 24 weeks, who were naturalistically followed-up for up to two years, revealed that adherent patients had a longer mean time to relapse.
No RCTs addressing the efficacy of maintenance treatment with antidepressants as compared to placebo were performed in primary care. Recommendations on maintenance treatment with antidepressants in primary care cannot be considered evidence-based.
长期使用抗抑郁药被认为能有效预防重性抑郁障碍（MDD）的复发。但这种治疗方法在初级保健中是否有效尚不清楚。
我们旨在研究初级保健中当前关于抗抑郁药长期治疗的指南建议是否有来自初级保健的证据支持。
研究抗抑郁药的数据源：PubMed、Cochrane 图书馆、Embase、PsycInfo、Cinahl、参考文献中的文章、引用参考文献搜索。
初级保健中的成年人，继续或维持抗抑郁药治疗，结局为复发或复发，（随机对照）试验/自然研究/综述。
2009 年 10 月前在英语国家发表的文献。
共收集了 13 项抑郁症指南。这些指南建议所有患者（包括来自初级保健的患者）在缓解后继续使用抗抑郁药治疗，对于那些有高复发风险的患者则进行维持治疗。关于治疗持续时间和高风险的定义，建议有所不同。我们筛选了 804 篇文献记录（标题、摘要），并考虑了 27 篇全文文章。仅有两项在初级保健中进行的研究探讨了抗抑郁药在复发性 MDD 长期治疗中的疗效。一项比较米氮平（n = 99）和帕罗西汀（n = 98）治疗 24 周的双盲 RCT 报告称，两组各有 2 例患者复发。一项对 1031 例接受舍曲林治疗 24 周的患者进行的开放性研究，这些患者自然随访了长达两年的时间，结果显示，依从性好的患者复发的平均时间更长。
没有 RCT 研究在初级保健中比较安慰剂的情况下评估抗抑郁药维持治疗的疗效。因此，初级保健中关于抗抑郁药维持治疗的建议不能被认为是基于证据的。
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