The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
J Affect Disord. 2020 Apr 15;267:123-130. doi: 10.1016/j.jad.2020.01.096. Epub 2020 Jan 21.
This is a meta-analysis of randomized controlled trials (RCTs) to examine the efficacy and safety of adjunctive folate for three major mental disorders (schizophrenia, bipolar disorder, and major depressive disorder (MDD)).
Review Manager Program Version 5.3 was used to analyze data.
Fourteen studies with 16 RCTs (n = 1,520) on folate for schizophrenia (4 RCTs, n = 210), mood disorders (i.e., unipolar and bipolar depression) (1 RCT, n = 60), bipolar disorder (2 RCTs, n = 189) and MDD (9 RCTs, n = 1,061) were analyzed separately by diagnosis. For schizophrenia, adjunctive folate was not superior to placebo in terms of total psychopathology (standardized mean difference (SMD) = -0.14, 95% confidential interval (CI): -0.67, 0.39; I = 30%, P = 0.60), and positive (SMD = 0.09, 95% CI: -0.44, 0.62; I = not applicable, P = 0.74), negative (SMD = -0.39, 95% CI:-0.84, 0.05; I = 50%, P = 0.08), and general symptom scores (SMD = -0.33, 95%CI:-0.87, 0.20; I = not applicable, P = 0.22). For bipolar and unipolar depression, adjunctive folate was significantly superior to placebo in improving depressive symptoms. For bipolar disorder, adjunctive folate was effective in treating the acute phase of mania in bipolar disorder, but not in the acute phase of depression. For MDD, adjunctive folate was significantly superior to placebo in improving depressive symptoms (SMD = -0.38, 95%CI: -0.66, -0.09; I = 71%, P = 0.01), which was confirmed in 5 of the 10 subgroups. Discontinuation due to any reason and adverse drug reactions were similar between folate and placebo in each diagnostic category.
This systematic review found adjunctive folate appeared to be effective and safe for MDD and bipolar manic episode, but it was not effective in treating schizophrenia.
这是一项对随机对照试验（RCT）的荟萃分析，旨在研究叶酸辅助治疗三种主要精神障碍（精神分裂症、双相情感障碍和重度抑郁症（MDD））的疗效和安全性。
使用 Review Manager 程序版本 5.3 分析数据。
对 14 项研究的 16 项 RCT（n=1520）进行了分析，这些研究涉及叶酸治疗精神分裂症（4 项 RCT，n=210）、心境障碍（即单相和双相抑郁）（1 项 RCT，n=60）、双相情感障碍（2 项 RCT，n=189）和 MDD（9 项 RCT，n=1061）。根据诊断结果，分别对精神分裂症、叶酸辅助治疗心境障碍和 MDD 进行了分析。对于精神分裂症，与安慰剂相比，叶酸辅助治疗在总体精神病学症状（标准化均数差（SMD）=-0.14，95%置信区间（CI）：-0.67，0.39；I²=30%，P=0.60）、阳性症状（SMD=0.09，95%CI：-0.44，0.62；I²：不适用，P=0.74）、阴性症状（SMD=-0.39，95%CI：-0.84，0.05；I²=50%，P=0.08）和一般症状评分（SMD=-0.33，95%CI：-0.87，0.20；I²：不适用，P=0.22）方面均无显著优势。对于双相和单相抑郁，叶酸辅助治疗在改善抑郁症状方面明显优于安慰剂。对于双相情感障碍，叶酸辅助治疗在治疗双相情感障碍的躁狂急性发作期有效，但对抑郁急性发作期无效。对于 MDD，与安慰剂相比，叶酸辅助治疗在改善抑郁症状方面有显著优势（SMD=-0.38，95%CI：-0.66，-0.09；I²=71%，P=0.01），在 10 个亚组中的 5 个亚组中得到了证实。在每个诊断类别中，因任何原因停药和药物不良反应在叶酸组和安慰剂组之间相似。
本系统评价发现，叶酸辅助治疗似乎对 MDD 和双相躁狂发作有效且安全，但对精神分裂症无效。
