Perna Giampaolo, Daccò Silvia, Alciati Alessandra, Cuniberti Francesco, De Berardis Domenico, Caldirola Daniela
Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, 22032 Albese con Cassano, Como, Italy.
Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, 22032 Albese con Cassano, Como, Italy.
Prog Neuropsychopharmacol Biol Psychiatry. 2021 Apr 20;107:110208. doi: 10.1016/j.pnpbp.2020.110208. Epub 2020 Dec 15.
Childhood maltreatment (CM) is a predictor of poor outcome across treatments for major depressive disorder (MDD), while its potential role as a predictor of differential responses to specific antidepressants has received little attention. The present systematic review examined pharmacological studies (published up to June 30th, 2020) that included head-to-head comparisons of antidepressant treatments among adult MDD patients with a reported history of CM or no history to evaluate if CM may help clinicians choose antidepressants with greatest likelihood of successful outcome. Only three studies were included, providing limited and provisional results. These preliminary findings suggest that sustained-release bupropion (alone or in combination) or aripiprazole-augmentation as next-step intervention did not demonstrate differential outcome among MDD patients with or without a history of childhood adversity. Further, sertraline and the group of antidepressants with low affinity for the serotonin transporter may be less suitable for MDD patients with childhood abuse history than escitalopram, venlafaxine-XR, or antidepressants with high affinity for the serotonin transporter. The critical question of the most potentially efficacious treatment regimens for adult MDD with CM history requires further large-sample studies involving a greater number of medications, specifically designed to analyse the moderating effects of different types of CM, and possibly including objective biomarkers.
童年期受虐（CM）是重度抑郁症（MDD）各种治疗效果不佳的一个预测因素，而其作为特定抗抑郁药不同反应预测因素的潜在作用却很少受到关注。本系统评价考察了（截至2020年6月30日发表的）药理学研究，这些研究对头对头比较了有童年期受虐史或无童年期受虐史的成年MDD患者的抗抑郁治疗，以评估童年期受虐是否有助于临床医生选择最有可能取得成功治疗结果的抗抑郁药。仅纳入了三项研究，提供的结果有限且具有临时性。这些初步研究结果表明，作为下一步干预措施，缓释安非他酮（单独使用或联合使用）或阿立哌唑增效在有或无童年期逆境史的MDD患者中并未显示出不同的治疗结果。此外，与艾司西酞普兰、文拉法辛缓释剂或对5-羟色胺转运体具有高亲和力的抗抑郁药相比，舍曲林以及对5-羟色胺转运体具有低亲和力的抗抑郁药组可能不太适合有童年期虐待史的MDD患者。对于有童年期受虐史的成年MDD患者，最具潜在疗效的治疗方案这一关键问题需要进一步开展大样本研究，涉及更多药物，专门设计用于分析不同类型童年期受虐的调节作用，并且可能包括客观生物标志物。
