From the ASPAG, CSM Licata, Licata.
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
J Clin Psychopharmacol. 2021;41(4):436-449. doi: 10.1097/JCP.0000000000001420.
PURPOSE/BACKGROUND: Bipolar disorder and major depressive disorder are heterogeneous conditions characterized by marked variations in mood. High levels of anxiety are often present in these conditions and are associated with increased suicidal risk, increased disease duration, and treatment resistance. Mood stabilizers or antipsychotics are recommended for the treatment of bipolar disorder in comorbidity with anxiety disorders. This study examines current knowledge to evaluate the efficacy of quetiapine in the treatment of anxiety in mood disorders.
METHODS/PROCEDURES: A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting randomized control trials that evaluated the efficacy of quetiapine on anxiety symptoms in patients diagnosed with bipolar disorder or major depressive disorder and included anxiety evaluation scales.
FINDINGS/RESULTS: We collected 27 studies (19 with primary data analysis, 8 with secondary data analysis) regarding the use of quetiapine in mood disorders. Quetiapine was more effective than placebo and active comparators in reducing anxiety in unipolar and bipolar patients in 20 of these studies. In 7 studies, quetiapine was not superior to psychoactive comparators or placebo on the anxiety dimension.
IMPLICATIONS/CONCLUSIONS: Statistical power might be limited by small sample size in 5 of the studies included in our review. Moreover, data on anxiety were a secondary outcome in most studies. Nevertheless, the reported studies show with good levels of concordance that quetiapine is effective in controlling anxiety symptoms in patients with mood disorders. This evidence supports current guidelines and recommendations concerning the use of quetiapine in clinical practice.
目的/背景：双相情感障碍和重度抑郁症是具有明显情绪变化的异质性疾病。这些疾病通常伴有较高水平的焦虑，与自杀风险增加、疾病持续时间延长和治疗抵抗有关。心境稳定剂或抗精神病药被推荐用于治疗伴有焦虑障碍的双相情感障碍。本研究通过评估喹硫平治疗心境障碍中焦虑的疗效来检验现有知识。
方法/程序：按照系统评价和荟萃分析（PRISMA）和 Cochrane 指南进行系统评价，选择评估喹硫平对双相情感障碍或重度抑郁症患者焦虑症状疗效的随机对照试验，并纳入焦虑评估量表。
结果/发现：我们共收集了 27 项关于喹硫平在心境障碍中应用的研究（19 项为原始数据分析，8 项为二次数据分析）。在其中 20 项研究中，喹硫平在单相和双相患者中比安慰剂和活性对照药物更能有效减轻焦虑。在 7 项研究中，喹硫平在焦虑维度上并不优于心理治疗药物或安慰剂。
我们纳入的研究中，有 5 项研究的样本量较小，可能会限制统计效力。此外，大多数研究中焦虑数据都是次要结局。然而，报告的研究以良好的一致性表明，喹硫平在控制心境障碍患者的焦虑症状方面是有效的。这一证据支持了当前关于喹硫平在临床实践中应用的指南和建议。
