Sugarman Michael A, Kirsch Irving, Huppert Jonathan D
Department of Psychology, Bedford Veterans Affairs Medical Center, United States.
Harvard Medical School, United States.
J Affect Disord. 2017 Aug 15;218:217-226. doi: 10.1016/j.jad.2017.04.068. Epub 2017 Apr 29.
Previous studies have indicated that obsessive-compulsive disorder (OCD) might have a reduced placebo response compared to other anxiety-related disorders including generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder. No previous analysis has directly compared antidepressant and placebo responses between OCD and these conditions.
We analyzed pre-post change scores within drug and placebo groups as well as between-groups change scores (i.e., drug compared to placebo) for all FDA-approved antidepressants for the treatment of these five anxiety-related disorders. Antidepressants included duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and venlafaxine. Random effects meta-analysis was used to examine all trials submitted to the FDA, plus additional post-approval trials available from manufacturer-sponsored clinical trial registers. Clinician-rated symptom inventories were the outcome measures for all conditions to facilitate comparisons across diagnoses.
Fifty-six trials met inclusion criteria. OCD had significantly lower pre-post effect sizes (ps<0.003) for both placebo (Hedges' g=0.49) and antidepressants (g=0.84) compared to the other four conditions (gs between 0.70 and 1.10 for placebo and 1.11 and 1.40 for antidepressants). However, the drug-placebo effect sizes did not significantly differ across diagnoses (Q(4)=6.09, p=0.193, I =34.3% [95% CI: -7.0,59.7]), with gs between=0.26 and 0.39.
Overall pre-post change scores were smaller for OCD compared to other anxiety disorders for both antidepressants and placebo, although drug-placebo effects sizes did not significantly differ across disorders. Theoretical and clinical implications for the understanding and treatment of OCD are discussed.
先前的研究表明，与其他焦虑相关障碍（包括广泛性焦虑症、恐慌症、创伤后应激障碍和社交焦虑症）相比，强迫症（OCD）的安慰剂反应可能较低。以前没有分析直接比较过强迫症与这些疾病之间的抗抑郁药和安慰剂反应。
我们分析了药物组和安慰剂组内的治疗前后变化分数，以及所有美国食品药品监督管理局（FDA）批准用于治疗这五种焦虑相关障碍的抗抑郁药的组间变化分数（即药物与安慰剂相比）。抗抑郁药包括度洛西汀、艾司西酞普兰、氟西汀、氟伏沙明、帕罗西汀、舍曲林和文拉法辛。采用随机效应荟萃分析来检查提交给FDA的所有试验，以及制造商赞助的临床试验登记处提供的额外批准后试验。临床医生评定的症状量表是所有疾病的结局指标，以便于跨诊断进行比较。
56项试验符合纳入标准。与其他四种疾病相比，强迫症在安慰剂（Hedges' g = 0.49）和抗抑郁药（g = 0.84）方面的治疗前后效应量显著较低（p<0.003）（安慰剂的g值在0.70至1.10之间，抗抑郁药的g值在1.11至1.40之间）。然而，不同诊断之间的药物-安慰剂效应量没有显著差异（Q(4)=6.09，p = 0.193，I = 34.3% [95% CI：-7.0,59.7]），g值在0.26至0.39之间。
与其他焦虑症相比，强迫症在抗抑郁药和安慰剂方面的总体治疗前后变化分数较小，尽管不同疾病之间的药物-安慰剂效应量没有显著差异。讨论了对强迫症理解和治疗的理论及临床意义。
