Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany.
BMJ Open. 2019 Aug 5;9(8):e028527. doi: 10.1136/bmjopen-2018-028527.
As clinical practice guidelines vary widely in their search strategies and recommendations of complementary and alternative medicine (CAM) for depression, this overview aimed at systematically summarising the level 1 evidence on CAM for patients with a clinical diagnosis of depression.
PubMed, PsycInfo and Central were searched for meta-analyses of randomised controlled clinical trials (RCTs) until 30 June 2018. Outcomes included depression severity, response, remission, relapse and adverse events. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the RCTs and meta-analyses, inconsistency, indirectness, imprecision of the evidence and the potential risk of publication bias.
The literature search revealed 26 meta-analyses conducted between 2002 and 2018 on 1-49 RCTs in major, minor and seasonal depression. In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John's wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John's wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality.
The effects of all but two CAM treatments found in studies on clinical depressed patients based on low to very low quality of evidence. The evidence has to be downgraded mostly due to avoidable methodological flaws of both the original RCTs and meta-analyses not following the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Further research is needed.
由于临床实践指南在补充和替代医学（CAM）治疗抑郁症的检索策略和建议方面差异很大，因此本综述旨在系统总结关于有临床诊断为抑郁症的患者的 CAM 的一级证据。
检索 PubMed、PsycInfo 和 Central 以获取截至 2018 年 6 月 30 日的随机对照临床试验（RCT）的荟萃分析。结局包括抑郁严重程度、反应、缓解、复发和不良事件。根据推荐、评估、制定和评估（GRADE）等级，根据 RCT 和荟萃分析的方法学质量、不一致性、间接性、证据的不精确性以及潜在的发表偏倚风险，评估证据质量。
文献检索发现了 26 项荟萃分析，这些分析是在 2002 年至 2018 年间对 1-49 项 RCT 进行的，涉及主要、次要和季节性抑郁症。在轻度至中度重度抑郁症患者中，中等质量证据表明贯叶金丝桃对安慰剂和其与标准抗抑郁药治疗抑郁症严重程度和反应率的比较有效性，而贯叶金丝桃导致的不良事件显著较少。在复发性重度抑郁症患者中，中等质量证据表明基于正念认知疗法优于标准抗抑郁药物治疗预防抑郁症复发。其他 CAM 证据被认为质量较低或非常低。
基于低至非常低质量证据，研究中发现的除两种 CAM 治疗外的所有治疗方法对临床抑郁患者都有效果。证据主要因原始 RCT 和荟萃分析未能遵循临床试验报告标准和系统评价和荟萃分析的首选报告项目指南而存在不可避免的方法学缺陷而被降级。需要进一步研究。
