Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany; Faculty of Medicine, Institute for Evidence in Medicine (for Cochrane Germany Foundation) Medical Center, University of Freiburg, Germany.
Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany.
Eur Neuropsychopharmacol. 2019 Sep;29(9):1003-1022. doi: 10.1016/j.euroneuro.2019.07.130. Epub 2019 Jul 18.
As there is currently no comprehensive evaluation about the efficacy and safety of interventions in elderly patients with major depressive disorder, we did a systematic review and network meta-analysis about all interventions in this population. We searched the specialised register of the Cochrane common mental disorders group, MEDLINE, EMBASE, PsycINFO, CochraneLibrary, ClinicalTrials.gov and the WHO registry until Dec 12, 2017 to identify all randomized controlled trials about the treatment of major depressive disorder in patients over an age of 65. The primary outcome was response defined as reduction of at least 50% on the Hamilton Depression Scale or any other validated depression scale. Secondary outcomes were remission, depressive symptoms, dropouts total, dropouts owing to inefficacy and dropouts due to adverse events, quality of life and social functioning. Additionally, we analysed 116 adverse events. We identified 129 references from 53 RCTs with 9274 participants published from 1990 to 2017. The mean participant age was 73.7 years. In terms of the primary outcome response to treatment the network-meta-analysis showed significant superiority compared to placebo for quetiapine and duloxetine; in addition, agomelatine, imipramine and vortioxetine outperformed placebo in pairwise meta-analyses, and there were also significant superiorities of several antidepressants compared to placebo in secondary efficacy outcomes. Very limited evidence suggests that competitive memory training, geriatric home treatment group and detached mindfulness condition reduce depressive symptoms. Several antidepressants and quetiapine have been shown to be efficacious in elderly patients with major depressive disorder, but due to the comparably few available data, the results are not robust. Differences in the multiple side-effects analysed should also be considered in drug choice. Although there were significant effects for some non-pharmacological treatments, the overall evidence for non-pharmacological treatments in major depressive disorder is insufficient, because it is based on a few trials with usually small sample sizes.
由于目前尚无关于老年重症抑郁症患者干预措施疗效和安全性的综合评价，我们对该人群的所有干预措施进行了系统评价和网络荟萃分析。我们检索了 Cochrane 普通精神障碍组专业登记处、MEDLINE、EMBASE、PsycINFO、Cochrane Library、ClinicalTrials.gov 和世界卫生组织注册中心，以确定截至 2017 年 12 月 12 日所有关于 65 岁以上患者重症抑郁症治疗的随机对照试验。主要结局是定义为汉密尔顿抑郁量表或任何其他验证性抑郁量表评分至少降低 50%的反应。次要结局是缓解、抑郁症状、总辍学、因无效而辍学和因不良反应而辍学、生活质量和社会功能。此外，我们还分析了 116 例不良事件。我们从 1990 年至 2017 年发表的 53 项 RCT 中确定了 129 篇参考文献，涉及 9274 名参与者。平均参与者年龄为 73.7 岁。就治疗反应的主要结局而言，与安慰剂相比，喹硫平和度洛西汀的网络荟萃分析显示出显著优势；此外，阿戈美拉汀、丙咪嗪和沃替西汀在两两荟萃分析中优于安慰剂，与安慰剂相比，几种抗抑郁药在次要疗效结局方面也具有显著优势。非常有限的证据表明，竞争性记忆训练、老年家庭治疗组和分离正念状态可减轻抑郁症状。几种抗抑郁药和喹硫平已被证明对老年重症抑郁症患者有效，但由于可用数据相对较少，结果并不稳健。在药物选择时还应考虑分析的多种副作用差异。虽然一些非药物治疗有显著效果，但非药物治疗重症抑郁症的总体证据不足，因为它基于一些试验，这些试验通常样本量较小。
