Pani Pier Paolo, Vacca Rosangela, Trogu Emanuela, Amato Laura, Davoli Marina
Social-Health Division, Health District 8 (ASL 8) Cagliari, Cittadella della Salute, padiglione C, via Romagna 16, Cagliari, Sardinia, Italy, 09127.
Cochrane Database Syst Rev. 2010 Sep 8(9):CD008373. doi: 10.1002/14651858.CD008373.pub2.
Lifetime prevalence of depression in subjects with opioid dependence is higher than in the general population (44-54% versus 16%) and represents a risk factor for morbidity and mortality. For patients on opioid agonist treatment, current prevalence rates of depression ranges between 10 and 30%, influencing negatively the outcome of the treatment.
To evaluate the efficacy and the acceptability of antidepressants for the treatment of depressed opioid dependents treated with opioid agonists.
We searched Pubmed, EMBASE, CINAHL (to October 2009), CENTRAL (The Cochrane Library Cochrane Drug and Alcohol Group Specialised Register, issue 4, 2009), main electronic sources of ongoing trials, specific trial databases and reference lists of all relevant papers.
Randomised and controlled clinical trials examining the efficacy of any antidepressant medication to treat depressed opioid dependents in treatment with opioid agonists.
Two authors independently screened and extracted data from studies.
Seven studies, 482 participants, met the inclusion criteria.- Comparing antidepressant with placebo, no statistically significant results for dropouts. Selecting studies with low risk of bias, 325 participants, results favour placebo, RR 1.40 (Cl 95% 1.00 to 1.96). For severity of depression, results from two studies, 183 participants, favour antidepressants utilising Clinical Global Impression Scale RR 1.92 (CI 95% 1.26 to 2.94), while another study, 95 participants, utilising the Hamilton Depression Rating Scale, did not find a statistically significant difference RR 0.96 (CI 95% 0.54 to 1.71). For adverse events, result favour placebo, four studies, 311 participants, RR 2.90 (Cl 95% 1.23 to 6.86). For drug use, three studies, 211 participants, it was not possible to pool data because outcomes' measures were not comparable. Looking at singular studies, no statistically significant difference was seen.- Comparing different classes of antidepressants, the results favour tricyclics for severity of depression, two studies, 183 participants, RR 1.92 (Cl 95% 1.26 to 2.94) and favour placebo for adverse events, two studies, 172 participants, RR 3.11 (Cl 95% 1.06 to 9.12).
AUTHORS' CONCLUSIONS: There is low evidence, at the present, supporting the clinical use of antidepressants for the treatment of depressed opioid addicts in treatment with opioid agonists. There is a need of larger randomised studies investigating relevant outcomes, safety issues and reporting data to allow comparison of results.
阿片类药物依赖者中抑郁症的终生患病率高于普通人群（44 - 54% 对比 16%），是发病和死亡的危险因素。对于接受阿片类激动剂治疗的患者，目前抑郁症患病率在 10% 至 30% 之间，对治疗结果产生负面影响。
评估抗抑郁药治疗接受阿片类激动剂治疗的抑郁阿片类药物依赖者的疗效和可接受性。
我们检索了 Pubmed、EMBASE、CINAHL（截至 2009 年 10 月）、CENTRAL（考克兰图书馆考克兰药物与酒精小组专业注册库，2009 年第 4 期）、正在进行试验的主要电子资源、特定试验数据库以及所有相关论文的参考文献列表。
随机对照临床试验，考察任何抗抑郁药物治疗接受阿片类激动剂治疗的抑郁阿片类药物依赖者的疗效。
两位作者独立筛选并从研究中提取数据。
七项研究，482 名参与者，符合纳入标准。 - 将抗抑郁药与安慰剂比较，脱落率无统计学显著差异。选择偏倚风险低的研究，325 名参与者，结果支持安慰剂，RR 1.40（95%CI 1.00 至 1.96）。对于抑郁严重程度，两项研究（183 名参与者）的结果支持使用临床总体印象量表的抗抑郁药，RR 1.92（95%CI 1.26 至 2.94），而另一项研究（95 名参与者）使用汉密尔顿抑郁量表未发现统计学显著差异，RR 0.96（95%CI 0.54 至 1.71）。对于不良事件，四项研究（311 名参与者）的结果支持安慰剂，RR 2.90（95%CI 1.23 至 6.86）。对于药物使用，三项研究（211 名参与者），由于结局测量不可比，无法汇总数据。查看个别研究，未发现统计学显著差异。 - 比较不同类别的抗抑郁药，对于抑郁严重程度，两项研究（183 名参与者）的结果支持三环类药物，RR 1.92（95%CI 1.26 至 2.94），对于不良事件，两项研究（172 名参与者）的结果支持安慰剂，RR 3.11（95%CI 1.06 至 9.12）。
目前，支持使用抗抑郁药治疗接受阿片类激动剂治疗的抑郁阿片类成瘾者的临床证据不足。需要进行更大规模的随机研究，调查相关结局、安全问题并报告数据，以便比较结果。
