Salagre Estela, Fernandes Brisa S, Dodd Seetal, Brownstein Daniel J, Berk Michael
Deakin University, IMPACT Strategic Research Centre, School of Medicine, and Barwon Health, Geelong, Australia; Hospital de la Santa Creu i Sant Pau, Servei de Psiquiatria, Barcelona, Spain.
Deakin University, IMPACT Strategic Research Centre, School of Medicine, and Barwon Health, Geelong, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
J Affect Disord. 2016 Aug;200:235-42. doi: 10.1016/j.jad.2016.04.047. Epub 2016 Apr 27.
In epidemiological studies, statins appear to benefit mood, and there are now some randomized controlled trials examining the efficacy of statins. However, the role of statins in depression remains uncertain. Thus the aim of this paper was to assess the effect of statins on depressive symptoms by performing a meta-analysis of all double-blind, randomized, placebo controlled clinical trials (RCT) conducted in subjects with depression.
A systematic search was executed using PubMed and ClinicalTrials.gov in November 30th, 2015 for all double-blind, RCT of statins versus placebo in persons with depressive symptoms. Sixty-seven potential articles were identified through search of electronic databases, of those three met inclusion criteria and were included in the meta-analysis. The outcome measure was change in Hamilton Depression Rating Scale (HDRS) scores associated with statin use. A meta-analysis was conducted and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. GRADE was used to assess study quality.
The three articles included provided data on 165 participants with moderate to severe depression. Of these, 82 were randomized to statins as an adjuvant therapy to antidepressant treatment (i.e., citalopram or fluoxetine) and 83 to the placebo arm. All studies were double-blind RCTs, with a follow-up of 6-12 weeks. The statin agents evaluated were lovastatin, atorvastatin, and simvastatin. When compared to placebo, statins, as add-on to treatment as usual, largely improved depressive symptoms as assessed by the HDRS (SMD=-0.73, 95% IC -1.04 to -0.42, p<0.001, 3 between-group comparisons, n=165). No serious adverse effects were reported.
Our results suggest that adjunctive treatment with statins could be useful for the treatment of depressive symptoms. Additional double-blind, randomised, placebo-controlled trials are necessary to settle the matter.
在流行病学研究中，他汀类药物似乎对情绪有益，目前有一些随机对照试验在研究他汀类药物的疗效。然而，他汀类药物在抑郁症中的作用仍不明确。因此，本文的目的是通过对所有针对抑郁症患者进行的双盲、随机、安慰剂对照临床试验（RCT）进行荟萃分析，来评估他汀类药物对抑郁症状的影响。
2015年11月30日，使用PubMed和ClinicalTrials.gov对所有关于他汀类药物与安慰剂治疗抑郁症状患者的双盲RCT进行系统检索。通过检索电子数据库确定了67篇潜在文章，其中3篇符合纳入标准并纳入荟萃分析。结局指标是与使用他汀类药物相关的汉密尔顿抑郁量表（HDRS）评分变化。进行荟萃分析并计算95%置信区间（CI）的标准化平均差（SMD）。采用GRADE评估研究质量。
纳入的3篇文章提供了165例中度至重度抑郁症患者的数据。其中，82例被随机分配接受他汀类药物作为抗抑郁治疗（即西酞普兰或氟西汀）的辅助治疗，83例被分配到安慰剂组。所有研究均为双盲RCT，随访6 - 12周。评估的他汀类药物制剂有洛伐他汀、阿托伐他汀和辛伐他汀。与安慰剂相比，他汀类药物作为常规治疗的附加用药，根据HDRS评估，在很大程度上改善了抑郁症状（SMD = -0.73，95% IC -1.04至-0.42，p < 0.001，3组间比较，n = 165）。未报告严重不良反应。
我们的结果表明，他汀类药物辅助治疗可能对抑郁症状的治疗有用。需要更多的双盲、随机、安慰剂对照试验来解决这一问题。
