Cipriani Andrea, Purgato Marianna, Furukawa Toshi A, Trespidi Carlotta, Imperadore Giuseppe, Signoretti Alessandra, Churchill Rachel, Watanabe Norio, Barbui Corrado
Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy.
Cochrane Database Syst Rev. 2012 Jul 11;2012(7):CD006534. doi: 10.1002/14651858.CD006534.pub2.
Recent US and UK clinical practice guidelines recommend that second-generation antidepressants should be considered amongst the best first-line options when drug therapy is indicated for a depressive episode. Systematic reviews have already highlighted some differences in efficacy between second-generation antidepressants. Citalopram, one of the first selective serotonin reuptake inhibitors (SSRI) introduced in the market, is one of these antidepressant drugs that clinicians use for routine depression care.
To assess the evidence for the efficacy, acceptability and tolerability of citalopram in comparison with tricyclics, heterocyclics, other SSRIs and other conventional and non-conventional antidepressants in the acute-phase treatment of major depression.
We searched The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Central Register of Controlled Trials up to February 2012. No language restriction was applied. We contacted pharmaceutical companies and experts in this field for supplemental data.
Randomised controlled trials allocating patients with major depression to citalopram versus any other antidepressants.
Two reviewers independently extracted data. Information extracted included study characteristics, participant characteristics, intervention details and outcome measures in terms of efficacy (the number of patients who responded or remitted), patient acceptability (the number of patients who failed to complete the study) and tolerability (side-effects).
Thirty-seven trials compared citalopram with other antidepressants (such as tricyclics, heterocyclics, SSRIs and other antidepressants, either conventional ones, such as mirtazapine, venlafaxine and reboxetine, or non-conventional, like hypericum). Citalopram was shown to be significantly less effective than escitalopram in achieving acute response (odds ratio (OR) 1.47, 95% confidence interval (CI) 1.08 to 2.02), but more effective than paroxetine (OR 0.65, 95% CI 0.44 to 0.96) and reboxetine (OR 0.63, 95% CI 0.43 to 0.91). Significantly fewer patients allocated to citalopram withdrew from trials due to adverse events compared with patients allocated to tricyclics (OR 0.54, 95% CI 0.38 to 0.78) and fewer patients allocated to citalopram reported at least one side effect than reboxetine or venlafaxine (OR 0.64, 95% CI 0.42 to 0.97 and OR 0.46, 95% CI 0.24 to 0.88, respectively).
AUTHORS' CONCLUSIONS: Some statistically significant differences between citalopram and other antidepressants for the acute phase treatment of major depression were found in terms of efficacy, tolerability and acceptability. Citalopram was more efficacious than paroxetine and reboxetine and more acceptable than tricyclics, reboxetine and venlafaxine, however, it seemed to be less efficacious than escitalopram. As with most systematic reviews in psychopharmacology, the potential for overestimation of treatment effect due to sponsorship bias and publication bias should be borne in mind when interpreting review findings. Economic analyses were not reported in the included studies, however, cost effectiveness information is needed in the field of antidepressant trials.
美国和英国近期的临床实践指南建议，当药物治疗适用于抑郁发作时，第二代抗抑郁药应被视为最佳一线选择之一。系统评价已经凸显了第二代抗抑郁药在疗效上的一些差异。西酞普兰是市场上最早推出的选择性5-羟色胺再摄取抑制剂（SSRI）之一，是临床医生用于常规抑郁症治疗的抗抑郁药物之一。
评估西酞普兰与三环类、杂环类、其他SSRI以及其他传统和非传统抗抑郁药相比，在重度抑郁症急性期治疗中的疗效、可接受性和耐受性证据。
我们检索了截至2012年2月的Cochrane协作网抑郁、焦虑和神经症对照试验注册库以及Cochrane对照试验中央注册库。未设语言限制。我们联系了制药公司和该领域的专家以获取补充数据。
将重度抑郁症患者随机分配接受西酞普兰或其他任何抗抑郁药治疗的对照试验。
两名评价员独立提取数据。提取的信息包括研究特征、参与者特征、干预细节以及疗效（有反应或缓解的患者数量）、患者可接受性（未完成研究的患者数量）和耐受性（副作用）方面的结局指标。
37项试验比较了西酞普兰与其他抗抑郁药（如三环类、杂环类、SSRI以及其他抗抑郁药，包括传统药物如米氮平、文拉法辛和瑞波西汀，或非传统药物如金丝桃属植物）。结果显示，在实现急性反应方面，西酞普兰的疗效显著低于艾司西酞普兰（比值比（OR）1.47，95%置信区间（CI）1.08至2.02），但高于帕罗西汀（OR 0.65，95%CI 0.44至0.96）和瑞波西汀（OR 0.63，95%CI 0.43至0.91）。与分配接受三环类药物治疗的患者相比，分配接受西酞普兰治疗的患者因不良事件退出试验的人数显著更少（OR 0.54，95%CI 0.38至0.78），且分配接受西酞普兰治疗的患者报告至少一种副作用的人数少于瑞波西汀或文拉法辛（分别为OR 0.64，95%CI 从0.42至0.97和OR 0.46，95%CI从0.24至0.88）。
在重度抑郁症急性期治疗中，西酞普兰与其他抗抑郁药在疗效、耐受性和可接受性方面存在一些统计学上的显著差异。西酞普兰比帕罗西汀和瑞波西汀更有效，比三环类、瑞波西汀和文拉法辛更可接受，然而，它似乎比艾司西酞普兰疗效更低。与精神药理学中的大多数系统评价一样，在解释评价结果时应牢记因资助偏倚和发表偏倚导致治疗效果高估的可能性。纳入的研究未报告经济分析，然而，抗抑郁药试验领域需要成本效益信息。
