第二代抗抑郁药治疗重度抑郁症的比较效益和危害：一项更新的荟萃分析。

Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis.

机构信息

Danube University, Krems, Austria.

出版信息

Ann Intern Med. 2011 Dec 6;155(11):772-85. doi: 10.7326/0003-4819-155-11-201112060-00009.

DOI:10.7326/0003-4819-155-11-201112060-00009

PMID:22147715

Abstract

BACKGROUND

Second-generation antidepressants dominate the management of major depressive disorder (MDD), but evidence on the comparative benefits and harms of these agents is contradictory.

PURPOSE

To compare the benefits and harms of second-generation antidepressants for treating MDD in adults.

DATA SOURCES

English-language studies from PubMed, Embase, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to August 2011 and reference lists of pertinent review articles and gray literature.

STUDY SELECTION

2 independent reviewers identified randomized trials of at least 6 weeks' duration to evaluate efficacy and observational studies with at least 1000 participants to assess harm.

DATA EXTRACTION

Reviewers abstracted data about study design and conduct, participants, and interventions and outcomes and rated study quality. A senior reviewer checked and confirmed extracted data and quality ratings.

DATA SYNTHESIS

Meta-analyses and mixed-treatment comparisons of response to treatment and weighted mean differences were conducted on specific scales to rate depression. On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of MDD. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions. Individual drugs differed in onset of action, adverse events, and some measures of health-related quality of life.

LIMITATIONS

Most trials were conducted in highly selected populations. Publication bias might affect the estimates of some comparisons. Mixed-treatment comparisons cannot conclusively exclude differences in efficacy. Evidence within subgroups was limited.

CONCLUSION

Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality.

摘要

背景

第二代抗抑郁药在治疗重度抑郁症（MDD）方面占据主导地位，但关于这些药物的相对益处和危害的证据存在矛盾。

目的

比较第二代抗抑郁药治疗成人 MDD 的疗效和安全性。

数据来源

从 1980 年至 2011 年 8 月，在 PubMed、Embase、Cochrane 图书馆、PsycINFO 和国际药学文摘等英文数据库中，以及相关综述文章和灰色文献的参考文献中，检索英语文献。

研究选择

2 位独立评审员分别识别了至少 6 周疗程的随机试验，以评估疗效，以及至少有 1000 名参与者的观察性研究，以评估危害。

数据提取

评审员提取了有关研究设计和实施、参与者、干预措施和结局的资料，并对研究质量进行了评分。一位资深评审员检查并确认了提取的数据和质量评分。

数据综合

对特定量表上的治疗反应和加权均数差值进行了荟萃分析和混合治疗比较，以评估抑郁程度。在 234 项研究的基础上，未发现治疗急性、延续和维持期 MDD 方面的疗效或有效性有任何临床相关差异。在伴有伴随症状的患者或根据年龄、性别、种族或合并症进行分组的患者中，疗效无差异。个别药物在作用开始时间、不良反应和一些健康相关生活质量指标上存在差异。