Puzhko Svetlana, Aboushawareb Sarah A E, Kudrina Irina, Schuster Tibor, Barnett Tracie A, Renoux Christel, Bartlett Gillian
Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, suite 300, H3S 1Z1, Montréal, QC, Canada.
Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, suite 300, H3S 1Z1, Montréal, QC, Canada; Department of Anesthesia, Faculty of Medicine, McGill University, 1001 Boulevard Décarie C05.2000, Montréal, QC H4A 3J1, Canada.
J Affect Disord. 2020 Apr 15;267:153-170. doi: 10.1016/j.jad.2020.01.113. Epub 2020 Feb 1.
Depression and obesity are debilitating conditions representing an enormous health and economic burden worldwide. Depression is common among patients with excess weight, but more importantly, these patients may be at risk for poor response when treated with antidepressant medications (AD).
We conducted a comprehensive scoping review to summarize the evidence regarding the difference in response to treatment of depression with AD among patients with excess weight as compared to normal weight patients and to identify knowledge gaps.
The search of the Medline and PsycINFO (2004-2019) identified twelve relevant studies. Tabulation and frequency analysis of the charted data along with a narrative synthesis were performed. Nine studies (75%) reported clinically relevant negative association between patients' high BMI or obesity and treatment response to either nortriptyline, fluoxetine, or various AD; one study (8.3%) reported no difference in response to various AD combinations between BMI groups. One study showed benefits of bupropion and escitalopram combination in patients with morbid obesity (BMI > 35 kg/m) as compared with escitalopram monotherapy. Another study reported benefits when using venlafaxine-XR in patients with morbid obesity. We also acknowledge the possible role of sex and genetic factors predicting AD treatment response.
The search was restricted to two most relevant sources, publications in four languages and adult population.
The synthesized data may be useful to physicians in their decision regarding the choice of AD in patients with excess weight. Researchers need to address causality of association between obesity and treatment response to individual AD types.
抑郁症和肥胖症是使人衰弱的病症，在全球范围内构成了巨大的健康和经济负担。抑郁症在超重患者中很常见，但更重要的是，这些患者在接受抗抑郁药物（AD）治疗时可能存在反应不佳的风险。
我们进行了一项全面的范围综述，以总结超重患者与正常体重患者相比在接受AD治疗抑郁症时反应差异的证据，并确定知识空白。
对Medline和PsycINFO（2004 - 2019年）的检索确定了12项相关研究。对图表数据进行了列表和频率分析，并进行了叙述性综合分析。九项研究（75%）报告称，患者的高BMI或肥胖与对去甲替林、氟西汀或各种AD的治疗反应之间存在临床相关的负相关；一项研究（8.3%）报告称BMI组之间对各种AD组合的反应没有差异。一项研究表明，与艾司西酞普兰单药治疗相比，安非他酮和艾司西酞普兰联合使用对病态肥胖（BMI > 35 kg/m）患者有益。另一项研究报告称，使用文拉法辛缓释剂对病态肥胖患者有益。我们也承认性别和遗传因素在预测AD治疗反应方面可能发挥的作用。
检索仅限于两个最相关的来源、四种语言的出版物和成年人群。
综合数据可能有助于医生在为超重患者选择AD时做出决策。研究人员需要解决肥胖与对个体AD类型治疗反应之间关联的因果关系。
