加巴喷丁在精神疾病治疗中的应用：一项系统综述。
Gabapentin Therapy in Psychiatric Disorders: A Systematic Review.
作者信息
Berlin Rachel K, Butler Paul M, Perloff Michael D
机构信息
Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts.
Department of Neurology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts.
出版信息
Prim Care Companion CNS Disord. 2015 Oct 22;17(5). doi: 10.4088/PCC.15r01821. eCollection 2015.
OBJECTIVE
Gabapentin is commonly used off-label in the treatment of psychiatric disorders with success, failure, and controversy. A systematic review of the literature was performed to elucidate the evidence for clinical benefit of gabapentin in psychiatric disorders.
DATA SOURCES
Bibliographic reference searches for gabapentin use in psychiatric disorders were performed in PubMed and Ovid MEDLINE search engines with no language restrictions from January 1, 1983, to October 1, 2014, excluding nonhuman studies. For psychiatric references, the keywords bipolar, depression, anxiety, mood, posttraumatic stress disorder (posttraumatic stress disorder and PTSD), obsessive-compulsive disorder (obsessive-compulsive disorder and OCD), alcohol (abuse, dependence, withdraw), drug (abuse, dependence, withdraw), opioid (abuse, dependence, withdraw), cocaine (abuse, dependence, withdraw), and amphetamine (abuse, dependence, withdraw) were crossed with gabapentin OR neurontin.
STUDY SELECTION AND DATA EXTRACTION
The resulting 988 abstracts were read by 2 reviewers; references were excluded if gabapentin was not a study compound or psychiatric symptoms were not studied. The resulting references were subsequently read, reviewed, and analyzed; 219 pertinent to gabapentin use in psychiatric disorders were retained. Only 34 clinical trials investigating psychiatric disorders contained quality of evidence level II-2 or higher.
RESULTS
Gabapentin may have benefit for some anxiety disorders, although there are no studies for generalized anxiety disorder. Gabapentin has less likely benefit adjunctively for bipolar disorder. Gabapentin has clearer efficacy for alcohol craving and withdrawal symptoms and may have a role in adjunctive treatment of opioid dependence. There is no clear evidence for gabapentin therapy in depression, PTSD prevention, OCD, or other types of substance abuse. Limitations of available data include variation in dosing between studies, gabapentin as monotherapy or adjunctive treatment, and differing primary outcomes between trials.
CONCLUSIONS
Further research is required to better clarify the benefit of gabapentin in psychiatric disorders.
目的
加巴喷丁常用于精神疾病治疗的非适应证用药，疗效有成功、失败及存在争议的情况。进行了一项文献系统综述，以阐明加巴喷丁治疗精神疾病临床获益的证据。
数据来源
在PubMed和Ovid MEDLINE搜索引擎中对1983年1月1日至2014年10月1日期间加巴喷丁用于精神疾病的文献参考进行检索，无语言限制，排除非人类研究。对于精神疾病参考文献，关键词双相情感障碍、抑郁、焦虑、情绪、创伤后应激障碍（创伤后应激障碍和PTSD）、强迫症（强迫症和OCD）、酒精（滥用、依赖、戒断）、药物（滥用、依赖、戒断）、阿片类药物（滥用、依赖、戒断）、可卡因（滥用、依赖、戒断）和苯丙胺（滥用、依赖、戒断）与加巴喷丁或Neurontin交叉检索。
研究选择和数据提取
2名评审员阅读了由此获得的988篇摘要；如果加巴喷丁不是研究化合物或未研究精神症状，则排除参考文献。随后对所得参考文献进行阅读、评审和分析；保留了219篇与加巴喷丁用于精神疾病相关的文献。仅34项调查精神疾病的临床试验包含II-2级或更高证据质量水平。
结果
加巴喷丁可能对某些焦虑症有益，尽管尚无针对广泛性焦虑症的研究。加巴喷丁作为双相情感障碍辅助用药获益的可能性较小。加巴喷丁对酒精渴望和戒断症状有更明确的疗效，可能在阿片类药物依赖的辅助治疗中发挥作用。没有明确证据表明加巴喷丁可用于治疗抑郁症、预防创伤后应激障碍、强迫症或其他类型的药物滥用。现有数据的局限性包括研究之间剂量的差异、加巴喷丁作为单一疗法或辅助治疗以及试验之间不同的主要结局。
结论
需要进一步研究以更好地阐明加巴喷丁在精神疾病中的获益情况。
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