The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Sydney Medical School, Nepean, Penrith, NSW, Australia.
Aliment Pharmacol Ther. 2012 Mar;35(5):493-500. doi: 10.1111/j.1365-2036.2011.04978.x. Epub 2012 Jan 13.
Noncardiac chest pain (NCCP) is a common condition, affecting approximately 25% of the general population. The cause of NCCP can be classified as gastro-oesophageal reflux disease (GERD)-related NCCP, where antireflux therapy is the main treatment modality or alternatively as non-GERD-related NCCP, where pain modulators, including antidepressants, are utilised.
To provide a systematic review evaluating the evidence for the use of antidepressants in the treatment of non-GERD-related NCCP.
A computerised literature and manual search was conducted to identify relevant randomised, placebo-controlled studies, published in any language for the evaluation of the effectiveness of antidepressant as a therapeutic intervention for NCCP.
Six randomised placebo-controlled trials of antidepressant treatment for NCCP were identified. The medications included were selective serotonin reuptake inhibitors [paroxetine (n = 2), sertraline (n = 1)], tricyclic antidepressant [impramine (n = 1)], serotonin-norepinephrine reuptake inhibitor [venlafaxine (n = 1)] and a triazolopyridine [trazodone (n = 1)]. The percentage reduction in chest pain was statistically significant with venlafaxine (50% vs. 10%; P < 0.001), sertraline (63% vs. 15%; P = 0.02) and imipramine (52% vs. 1%; P = 0.03). The improvement in chest pain symptoms was independent of improvement in depression scores. Clinical global improvement also significantly improved in patients on venlafaxine, sertraline, paroxetine and trazodone. The percentage of patients in treatment groups reporting adverse effects were relatively high compared with those in placebo groups, although majority were statistically insignificant or significance was not reported. Nonetheless, adverse events were the reported reason for discontinuation of trials in 53% of patients from the antidepressant groups compared with 29% from the placebo group.
There is modest evidence for the benefit of antidepressants in reducing NCCP and improving patients' general health. However, there is significant heterogeneity amongst the studies with several study limitations to warrant more rigorous trials and to assess the usefulness of low-dose antidepressants in non-GERD NCCP.
非心源性胸痛（NCCP）是一种常见病症，影响大约 25%的普通人群。NCCP 的病因可分为胃食管反流病（GERD）相关 NCCP，其中抗反流治疗是主要的治疗方式；或者是非 GERD 相关 NCCP，其中使用疼痛调节剂，包括抗抑郁药。
提供一篇系统综述，评估抗抑郁药治疗非 GERD 相关 NCCP 的证据。
通过计算机检索和手动检索，以任何语言发表的评估抗抑郁药作为 NCCP 治疗干预措施的有效性的随机、安慰剂对照研究，以确定相关研究。
共确定了 6 项关于 NCCP 抗抑郁治疗的随机安慰剂对照试验。研究中使用的药物包括选择性 5-羟色胺再摄取抑制剂[帕罗西汀（n = 2），舍曲林（n = 1）]、三环类抗抑郁药[丙咪嗪（n = 1）]、5-羟色胺-去甲肾上腺素再摄取抑制剂[文拉法辛（n = 1）]和三唑吡啶[曲唑酮（n = 1）]。文拉法辛（50%对 10%；P < 0.001）、舍曲林（63%对 15%；P = 0.02）和丙咪嗪（52%对 1%；P = 0.03）的胸痛缓解百分比具有统计学意义。胸痛症状的改善与抑郁评分的改善无关。文拉法辛、舍曲林、帕罗西汀和曲唑酮组的临床总体改善也显著改善。与安慰剂组相比，接受治疗的患者报告不良反应的比例相对较高，尽管大多数无统计学意义或未报告统计学意义。尽管如此，与安慰剂组（29%）相比，抗抑郁药组（53%）的患者因不良反应而退出试验的比例较高。
抗抑郁药在减轻 NCCP 和改善患者整体健康方面有适度的益处。然而，研究之间存在显著的异质性，且存在一些研究局限性，因此需要更严格的试验来评估非 GERD NCCP 中低剂量抗抑郁药的有用性。
