颅脑损伤后抑郁症状的药物和非药物治疗的疗效：系统评价和网络荟萃分析。
Therapeutic benefits of pharmacologic and nonpharmacologic treatments for depressive symptoms after traumatic brain injury: a systematic review and network meta-analysis.
机构信息
From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun).
出版信息
J Psychiatry Neurosci. 2021 Jan 21;46(1):E196-E207. doi: 10.1503/jpn.190122.
BACKGROUND
Depression is a common morbidity after traumatic brain injury. This network meta-analysis investigated the efficacy and tolerability of pharmacologic and nonpharmacologic interventions for depression after traumatic brain injury.
METHODS
We extracted randomized controlled trials examining pharmacologic or nonpharmacologic interventions with placebo- or active-controlled designs from PubMed, the Cochrane Library and ScienceDirect, from inception to October 30, 2018. We based study selection and extraction of a predefined list of variables on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, and conducted meta-analysis procedures using random effects modelling. Primary outcomes were changes in depressive symptom severity after pharmacologic or nonpharmacologic treatment; the secondary outcome was tolerability, reflected in overall patient dropout rates.
RESULTS
Our analysis of 27 randomized controlled trials (10 pharmacologic, total n = 483, mean age = 37.9 yr; 17 nonpharmacologic, total n = 1083, mean age = 38.0 yr) showed that methylphenidate had significantly superior efficacy compared to placebo or control (standardized mean difference -0.91, 95% confidence interval [CI] -1.49 to -0.33). Sertraline was associated with significantly lower tolerability (i.e., a higher dropout rate) compared to placebo or control (odds ratio 2.65, 95% CI 1.27 to 5.54). No nonpharmacologic treatment was more effective than the others, and we found no significant differences in tolerability (i.e., dropout rates) among the nonpharmacologic treatments.
LIMITATIONS
Heterogeneity in participant characteristics (e.g., comorbidities), study designs (e.g., trial duration) and psychopathology assessment tools, as well as small trial numbers for some treatment arms, could have been confounders.
CONCLUSION
The present network meta-analysis suggests that methylphenidate might be the best pharmacologic intervention for depressive symptoms related to traumatic brain injury. None of the nonpharmacologic interventions was associated with better improvement in depressive symptoms than the others or than control conditions. None of the pharmacologic or nonpharmacologic treatments had inferior tolerability compared to placebo or controls except for sertraline, which had significantly lower tolerability than placebo.
背景
抑郁是颅脑外伤后的常见并发症。本网络荟萃分析旨在调查颅脑外伤后药物和非药物干预治疗抑郁的疗效和耐受性。
方法
我们从 PubMed、Cochrane 图书馆和 ScienceDirect 提取了以安慰剂或阳性对照为设计的药物或非药物干预治疗颅脑外伤后抑郁的随机对照试验。我们根据系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南选择研究和提取预设变量列表，并使用随机效应模型进行荟萃分析。主要结局是药物或非药物治疗后抑郁症状严重程度的变化；次要结局是反映整体患者脱落率的耐受性。
结果
我们对 27 项随机对照试验（10 项药物治疗，共 483 例患者，平均年龄 37.9 岁；17 项非药物治疗，共 1083 例患者，平均年龄 38.0 岁）进行分析，结果显示哌醋甲酯的疗效明显优于安慰剂或对照组（标准化均数差-0.91，95%置信区间 [CI] -1.49 至 -0.33）。舍曲林的耐受性明显低于安慰剂或对照组（即脱落率更高）（比值比 2.65，95% CI 1.27 至 5.54）。没有一种非药物治疗方法比其他方法更有效，而且我们没有发现非药物治疗方法之间在耐受性（即脱落率）方面存在显著差异。
局限性
由于参与者特征（如合并症）、研究设计（如试验持续时间）和精神病理学评估工具的异质性，以及某些治疗组的小型试验数量，可能存在混杂因素。
结论
本网络荟萃分析表明，哌醋甲酯可能是治疗颅脑外伤相关抑郁症状的最佳药物干预方法。与其他药物或对照条件相比，没有一种非药物干预方法在改善抑郁症状方面更有效。除了舍曲林，所有药物和非药物治疗方法的耐受性都不比安慰剂或对照组差，舍曲林的耐受性明显低于安慰剂。
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