Rohden Adriane Isabel, Benchaya Mariana Canellas, Camargo Roger Santos, Moreira Taís de Campos, Barros Helena M T, Ferigolo Maristela
Pharmacosciences Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Pharmacosciences Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Clin Ther. 2017 May;39(5):971-992.e4. doi: 10.1016/j.clinthera.2017.03.017. Epub 2017 May 2.
Depression currently affects 350 million people, and its prevalence among adolescents is 4% to 8%. Adolescents who abandon antidepressant treatment or drop out of clinical trials are less likely to recover or experience a remission of symptoms because they are not being followed up by a medical team. The objective of this study was to analyze the dropout rates of randomized clinical trials of depressed adolescents receiving treatment with antidepressant drugs and the factors associated with nonadherence by summarizing this information in a systematic review and meta-analysis.
Articles were retrieved from MEDLINE, EMBASE, Cochrane, Clinical Trial, PsycINFO, and Web of Science using the MeSH terms "depressive disorder," "randomized trials," and "adolescents." The evaluation of study quality was performed by using the Cochrane Handbook for Systematic Reviews of Interventions and the Jadad scale.
The final sample included 50 articles, of which 44 presented dropout rates. The overall dropout prevalence was 23% (95% CI, 20-27; P < 0.0001). Participants aged ≥16 years, those treated with serotonin norepinephrine reuptake inhibitors, and those receiving medication only exhibited the highest dropout prevalence, respectively (33% [95% CI, 27-39], 45% [95% CI, 31-64], and 15% [95% CI, 13-17]). The adverse effects most associated with dropout were attempted suicide followed by mania, skin rash, and headache. Problems relating to clinical trials and family arbitration were also related with dropout.
Serotonin/norepinephrine reuptake inhibitor treatment, adolescent age >16 years, and receiving medication were the only factors demonstrating a higher association with dropout rates. Selective serotonin reuptake inhibitors were linked to the lowest prevalence, probably due to fewer perceived problems with related adverse effects and higher efficacy in adolescents. Cognitive-behavioral therapy combined with pharmacotherapy produced a lower nonadherence prevalence; this approach can be an alternative to avoid dropouts and relapse. Prospero identifier: CRD42014013475.
抑郁症目前影响着3.5亿人，其在青少年中的患病率为4%至8%。放弃抗抑郁治疗或退出临床试验的青少年康复或症状缓解的可能性较小，因为他们没有得到医疗团队的随访。本研究的目的是通过系统评价和荟萃分析总结相关信息，分析接受抗抑郁药物治疗的抑郁青少年随机临床试验的脱落率以及与不依从相关的因素。
使用医学主题词“抑郁症”“随机试验”和“青少年”从MEDLINE、EMBASE、Cochrane、临床试验、PsycINFO和科学网检索文章。采用Cochrane干预措施系统评价手册和Jadad量表进行研究质量评估。
最终样本包括50篇文章，其中44篇给出了脱落率。总体脱落率为23%（95%CI，20 - 27；P < 0.0001）。年龄≥16岁的参与者、接受5-羟色胺去甲肾上腺素再摄取抑制剂治疗的参与者以及仅接受药物治疗的参与者分别表现出最高的脱落率（33%[95%CI，27 - 39]、45%[95%CI，31 - 64]和15%[95%CI，13 - 17]）。与脱落最相关的不良反应是自杀未遂，其次是躁狂、皮疹和头痛。与临床试验和家庭仲裁相关的问题也与脱落有关。
5-羟色胺/去甲肾上腺素再摄取抑制剂治疗、青少年年龄>16岁以及接受药物治疗是仅有的与脱落率有较高关联的因素。选择性5-羟色胺再摄取抑制剂与最低的患病率相关，这可能是由于其相关不良反应的问题较少且在青少年中疗效较高。认知行为疗法联合药物治疗产生的不依从患病率较低；这种方法可以作为避免脱落和复发的一种替代方案。Prospero标识符：CRD42014013475。
