Xu Y, Bai S J, Lan X H, Qin B, Huang T, Xie P
Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.
Chongqing Key Laboratory of Neurobiology, Chongqing, China.
Braz J Med Biol Res. 2016 May 24;49(6). doi: 10.1590/1414-431X20164806.
New generation antidepressant therapies, including serotonin-norepinephrine reuptake inhibitor (SNRIs), were introduced in the late 1980s; however, few comprehensive studies have compared the benefits and risks of various contemporary treatments for major depressive disorder (MDD) in young patients. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science, and PsycINFO databases was conducted from 1970 to January 2015. Only clinical trials that randomly assigned one SNRI or placebo to patients aged 7 to 18 years who met the diagnostic criteria for major depressive disorder were included. Treatment success, dropout rate, and suicidal ideation/attempt outcomes were measured. Primary efficacy was determined by pooling the risk ratios (RRs) of treatment response and remission. Acceptability was determined by pooling the RRs of dropouts for all reasons and for adverse effects as well as suicide-risk outcomes. Five trials with a total of 973 patients were included. SNRIs were not significantly more effective than placebo for treatment response but were for remission. The comparison of patients taking SNRIs that dropped out for all reasons and those taking placebo did not reach statistical significance. Significantly more patients taking SNRIs dropped out for adverse effects than those taking placebo. No significant difference was found in suicide-related risk outcomes. SNRI therapy does not display a superior efficacy and is not better tolerated compared to placebo in these young patients. However, duloxetine has a potential beneficial effect for depression in young populations, showing a need for further research.
新一代抗抑郁疗法，包括5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs），于20世纪80年代末问世；然而，很少有全面的研究比较过各种当代疗法对年轻患者重性抑郁障碍（MDD）的利弊。我们对1970年至2015年1月期间的PubMed、Cochrane、Embase、科学网和PsycINFO数据库进行了全面的文献检索。仅纳入了将一种SNRI或安慰剂随机分配给符合重性抑郁障碍诊断标准的7至18岁患者的临床试验。测量了治疗成功率、脱落率以及自杀意念/企图结果。主要疗效通过汇总治疗反应和缓解的风险比（RRs）来确定。可接受性通过汇总因各种原因、不良反应以及自杀风险结果导致的脱落RRs来确定。共纳入了五项试验，涉及973名患者。在治疗反应方面，SNRIs并不比安慰剂显著更有效，但在缓解方面则不然。将因各种原因退出的服用SNRIs的患者与服用安慰剂的患者进行比较，未达到统计学显著性。因不良反应而退出的服用SNRIs的患者明显多于服用安慰剂的患者。在自杀相关风险结果方面未发现显著差异。在这些年轻患者中，与安慰剂相比，SNRI疗法并未显示出更优的疗效，耐受性也没有更好。然而，度洛西汀对年轻人群的抑郁症可能有有益作用，这表明有必要进行进一步研究。
