Deb Shoumitro, Roy Meera, Lee Rachel, Majid Madiha, Limbu Bharati, Santambrogio Jacopo, Roy Ashok, Bertelli Marco O
Department of Brain Sciences, Faculty of Medicine, Imperial College London, UK.
Department of Psychiatry, Hereford and Worcestershire Health and Care NHS Trust, UK.
BJPsych Open. 2021 Oct 1;7(6):e179. doi: 10.1192/bjo.2021.1003.
Although widely used, the current evidence for the efficacy of antidepressant and anti-anxiety medications for people with autism spectrum disorder (ASD) is limited and conflicting.
We carried out a systematic review and meta-analysis of randomised controlled trials that assessed the effectiveness of these medications in people with ASD.
We searched the following databases: Cochrane Library, Medline, EMBASE, CINAHL, PsycINFO, ERIC, DARE and ClinicalTrials.gov. Additionally, we hand-searched 11 relevant journals. We used the Cochrane risk-of-bias tool and Jadad score to assess the quality of each included study. We carried out a meta-analysis using a random effects model.
We included 15 randomised controlled trials (13 on antidepressants and two on anti-anxiety medications) for a total of 958 people with ASD. Data showed contradictory findings among the studies, with larger studies mostly showing a non-significant difference in outcomes between the treatment and the placebo groups. Meta-analysis of pooled Yale-Brown Obsessive Compulsive Scale and Clinical Global Impression Scale data from nine studies (60%) did not show any statistically significant inter-group difference on either of the outcome measures. The adverse effects reported were mild and, in most studies, their rates did not show any significant inter-group difference.
Given the methodological flaws in the most included studies and contradictory findings, it is difficult to draw any definitive conclusion about the effectiveness of either antidepressant or anti-anxiety medications to treat either ASD core symptoms or associated behaviours. Robust, large-scale, randomised controlled trials are needed to address this issue.
尽管抗抑郁药和抗焦虑药在自闭症谱系障碍（ASD）患者中广泛使用，但目前关于这些药物疗效的证据有限且相互矛盾。
我们对评估这些药物在ASD患者中有效性的随机对照试验进行了系统评价和荟萃分析。
我们检索了以下数据库：Cochrane图书馆、Medline、EMBASE、CINAHL、PsycINFO、ERIC、DARE和ClinicalTrials.gov。此外，我们手工检索了11种相关期刊。我们使用Cochrane偏倚风险工具和Jadad评分来评估每项纳入研究的质量。我们使用随机效应模型进行荟萃分析。
我们纳入了15项随机对照试验（13项关于抗抑郁药，2项关于抗焦虑药），共958名ASD患者。数据显示各研究结果相互矛盾，规模较大的研究大多显示治疗组和安慰剂组在结局上无显著差异。对9项研究（60%）汇总的耶鲁-布朗强迫量表和临床总体印象量表数据进行的荟萃分析显示，在任何一项结局指标上，组间均无统计学显著差异。报告的不良反应较轻，在大多数研究中，其发生率在组间未显示出任何显著差异。
鉴于大多数纳入研究存在方法学缺陷且结果相互矛盾，很难就抗抑郁药或抗焦虑药治疗ASD核心症状或相关行为的有效性得出任何明确结论。需要开展有力的、大规模的随机对照试验来解决这一问题。
