Gebhardt Stefan, Heinzel-Gutenbrunner Monika, König Udo
From the Departments of *Psychiatry and Psychotherapy and †Child and Adolescent Psychiatry, Philipps-University of Marburg, Marburg, Germany.
J Clin Psychopharmacol. 2016 Dec;36(6):658-668. doi: 10.1097/JCP.0000000000000604.
Pain is a common symptom in patients with depressive disorders, which, if present, worsens the prognosis. However, there is little empirical knowledge of the therapeutic effects of antidepressants on painful physical symptoms of patients with depressive disorders. Furthermore, tricyclic/tetracyclic antidepressants (TCAs) have not yet been included in existing meta-analyses.
A broad, systematic search of PubMed literature on antidepressant drug treatment of patients with depressive disorders with comorbid pain symptoms was carried out. A random-effects meta-analysis has been performed among 3 different groups of drugs for the 2 end points: pain and depression.
Fourteen placebo-controlled studies with selective serotonin-noradrenaline reuptake inhibitors (SSNRIs) could be included, with 3 of them also investigating selective serotonin reuptake inhibitors (SSRIs). Three further placebo-controlled SSRI studies were identified, but only 2 placebo-controlled TCA studies.Both SSNRIs and SSRIs, but not TCAs, were significantly superior to placebo as regards their analgesic effects. However, all effects were small. For SSNRIs, there was a strong positive correlation between their effectiveness for pain relief and their positive effect on the mood of the patients.
The analgesic effects of SSNRIs and SSRIs in patients with primary depressive disorders can be interpreted as largely equivalent. Because of a lack of placebo-controlled TCA studies, the results for TCAs would be comparable only to those of SSRIs and SSNRIs, if non-placebo-controlled TCA studies were included. The positive correlation found indicates a close relationship of pain relief and antidepressant treatment effects. These results refer merely to patients with primary depressive disorders, not to patients with primary pain disorders. Further studies comparing the effects of different types of antidepressant drugs on pain in depressive patients are warranted.
疼痛是抑郁症患者的常见症状，若存在疼痛症状会使预后恶化。然而，关于抗抑郁药对抑郁症患者疼痛性躯体症状的治疗效果，实证知识较少。此外，三环/四环类抗抑郁药（TCAs）尚未纳入现有的荟萃分析。
对PubMed文献进行广泛、系统的检索，以查找关于合并疼痛症状的抑郁症患者抗抑郁药物治疗的研究。针对疼痛和抑郁这两个终点，在3组不同药物之间进行了随机效应荟萃分析。
可以纳入14项使用选择性5-羟色胺-去甲肾上腺素再摄取抑制剂（SSNRIs）的安慰剂对照研究，其中3项还研究了选择性5-羟色胺再摄取抑制剂（SSRIs）。另外确定了3项安慰剂对照的SSRI研究，但仅有2项安慰剂对照的TCA研究。在镇痛效果方面，SSNRIs和SSRIs均显著优于安慰剂，但TCA并非如此。然而，所有效果都较小。对于SSNRIs，其缓解疼痛的有效性与对患者情绪的积极影响之间存在很强的正相关性。
SSNRIs和SSRIs对原发性抑郁症患者的镇痛效果在很大程度上可被视为等效。由于缺乏安慰剂对照的TCA研究，如果纳入非安慰剂对照的TCA研究，TCA的结果仅能与SSRIs和SSNRIs的结果进行比较。所发现的正相关性表明疼痛缓解与抗抑郁治疗效果之间存在密切关系。这些结果仅适用于原发性抑郁症患者，不适用于原发性疼痛障碍患者。有必要进一步开展研究，比较不同类型抗抑郁药物对抑郁症患者疼痛的影响。
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