Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany.
Charité University Medicine, St Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Berlin, Germany.
J Clin Psychiatry. 2018 May/Jun;79(3). doi: 10.4088/JCP.17r11470.
In patients who are not responding to antidepressant pharmacotherapy, information regarding the future probability of response with the same treatment is scarce. Specifically, it is unclear at what point in time the probability to respond or remit ceases to increase, because few studies report data on response or remission at repeated time points beyond 4 or 8 weeks of treatment. Consequently, treatment recommendations in clinical practice guidelines differ widely.
We systematically searched MEDLINE, Embase, PsycINFO, and CENTRAL databases through March 2014 using generic terms for depressive or affective disorders, individual drug names, and placebo (Prospero Registration: CRD42014010105).
We identified double-blind, randomized studies with continuous outcome reporting from 4 weeks up to at least 12 weeks that compared antidepressant monotherapy to placebo in adult patients suffering from acute depressive disorder.
Data extraction and synthesis followed Cochrane Collaboration guidelines. Primary outcome was response; secondary outcomes were remission and changes in rating scale scores in previously unresponsive patients, respectively.
Of 6,043 articles screened, we selected 9 studies including 3,466 patients. Altogether, 21.6% (18.6%, 24.9%) of previously nonresponsive patients achieved response with ongoing antidepressant treatment between weeks 5 and 8, and 9.9% (7.5%, 12.7%), between weeks 9 and 12. Probability of response when taking placebo was 13.0% (9.9%, 16.5%) between weeks 5 and 8 and 2.4% (1.2%, 4.6%) between weeks 9 and 12. Differences in the probability of response between antidepressant and placebo translated into a number needed to treat of 11 after 4 weeks and 17 after 8 weeks. Heterogeneity was low to moderate, and results remained stable across subgroup and sensitivity analyses.
In patients unresponsive to antidepressant pharmacotherapy, improvements in psychopathology can be expected with ongoing antidepressant treatment for up to 3 months. After 8 weeks of treatment, improvement with ongoing monotherapy is relatively small.
对于那些对抗抑郁药物治疗没有反应的患者，关于同一治疗方法未来反应概率的信息很少。具体来说，由于很少有研究报告在治疗 4 或 8 周后重复时间点的反应或缓解数据，因此不清楚反应或缓解的概率何时停止增加。因此，临床实践指南中的治疗建议差异很大。
我们通过 2014 年 3 月的 MEDLINE、Embase、PsycINFO 和 CENTRAL 数据库，使用抑郁或情感障碍的通用术语、个别药物名称和安慰剂（Prospéro 注册：CRD42014010105）进行了系统搜索。
我们确定了 9 项研究，这些研究为双盲、随机研究，具有从 4 周持续到至少 12 周的连续结果报告，比较了抗抑郁药单药治疗与安慰剂在患有急性抑郁障碍的成年患者中的疗效。
数据提取和综合遵循 Cochrane 协作组的指南。主要结果是反应；次要结果分别为无反应患者的缓解和评定量表评分的变化。
在筛选出的 6043 篇文章中，我们选择了 9 项研究，包括 3466 名患者。总的来说，在第 5 至 8 周期间，有 21.6%（18.6%，24.9%）的先前无反应患者继续接受抗抑郁治疗后出现反应，在第 9 至 12 周期间，有 9.9%（7.5%，12.7%）出现反应。在第 5 至 8 周期间，服用安慰剂的反应概率为 13.0%（9.9%，16.5%），在第 9 至 12 周期间，反应概率为 2.4%（1.2%，4.6%）。抗抑郁药与安慰剂之间反应概率的差异转化为在第 4 周时的治疗需要数为 11，在第 8 周时为 17。异质性低至中度，且结果在亚组和敏感性分析中保持稳定。
对于对抗抑郁药物治疗无反应的患者，在接受抗抑郁药物治疗长达 3 个月的时间内，精神病理学的改善是可以预期的。在治疗 8 周后，继续单药治疗的效果相对较小。
