Sarkar Susanne, Schaefer Martin
Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany; Department of Psychiatry, Psychotherapy and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany.
Psychosomatics. 2014 May-Jun;55(3):221-34. doi: 10.1016/j.psym.2013.06.015. Epub 2013 Sep 5.
Depression is a major complication during treatment with interferon alfa (IFN-α).
The aim of this study was to clarify whether preemptive antidepressant treatment can reduce the incidence and severity of IFN-associated depression.
Based on a systematic review of the literature up to July 2012, a meta-analysis of the data from 8 trials investigating patients with malignant melanoma or hepatitis C was performed. The influence of antidepressants on the incidence of major depression and depression severity was defined as the primary outcome and the influence of somatic disorder, psychiatric comorbidity, type of antidepressants, type of IFN, and possible effects on treatment outcome as secondary outcome criteria.
Antidepressant pretreatment reduced the overall incidence of major depression during IFN treatment in all patients (odds ratio = 0.42; 95% confidence interval, 0.26-0.68; p < 0.001, n = 589) and was associated with lower mean depression scores after 12 weeks of IFN treatment (g = -0.37; 95% confidence interval -0.59 to -0.18; p < 0.001, n = 375). For patients with hepatitis C virus infection, antidepressants reduced the incidence of major depression (odds ratio = 0.38; 95% confidence interval 0.22-0.66; p < 0.001, n = 549) and the mean depression scores after 24 weeks of IFN treatment (g = -0.50; 95% confidence interval -0.70 to -0.29; p < 0.001, n = 335). The effects of selective serotonin reuptake inhibitors on the incidence and severity of depression were not dependent on pre-existing psychiatric disorders.
Antidepressant pretreatment with selective serotonin reuptake inhibitors lowers the incidence and severity of IFN-associated depression in patients with chronic hepatitis C infection or malignant melanoma.
抑郁症是干扰素α（IFN-α）治疗期间的主要并发症。
本研究旨在阐明预防性抗抑郁治疗是否可降低IFN相关抑郁症的发生率和严重程度。
基于对截至2012年7月的文献进行的系统评价，对8项针对恶性黑色素瘤或丙型肝炎患者的试验数据进行荟萃分析。抗抑郁药对重度抑郁症发生率和抑郁严重程度的影响被定义为主要结局，躯体疾病、精神共病、抗抑郁药类型、IFN类型以及对治疗结局的可能影响作为次要结局标准。
抗抑郁药预处理降低了所有患者IFN治疗期间重度抑郁症的总体发生率（比值比=0.42；95%置信区间，0.26 - 0.68；p<0.001，n = 589），并且与IFN治疗12周后的平均抑郁评分较低相关（g = -0.37；95%置信区间 -0.59至 -0.18；p<0.001，n = 375）。对于丙型肝炎病毒感染患者，抗抑郁药降低了重度抑郁症的发生率（比值比=0.38；95%置信区间0.22 - 0.66；p<0.001，n = 549）以及IFN治疗24周后的平均抑郁评分（g = -0.50；95%置信区间 -0.70至 -0.29；p<0.001，n = 335）。选择性5-羟色胺再摄取抑制剂对抑郁症发生率和严重程度的影响不依赖于既往精神疾病。
选择性5-羟色胺再摄取抑制剂进行抗抑郁药预处理可降低慢性丙型肝炎感染或恶性黑色素瘤患者中IFN相关抑郁症的发生率和严重程度。
