Fernandes Beatriz Monteiro, Scotti-Muzzi Estêvão, Soeiro-de-Souza Márcio Gerhardt
Department and Institute of Psychiatry, Hospital das Cllínicas, School of Medicine, University of São Paulo (IPq HC-FMUSP), Dr. Ovidio Pires de Campos s/n, São Paulo, 05403-010, Brazil.
Eur J Clin Pharmacol. 2022 Mar;78(3):339-349. doi: 10.1007/s00228-021-03240-8. Epub 2021 Oct 27.
To conduct a systematic review and meta-analysis of the effects of antidepressant drug therapy (with or without physical exercise) on peripheral inflammatory markers in patients with major depressive disorder (MDD).
MEDLINE, PyscINFO, Embase, and Google Scholar databases were searched until May 2020. Randomized trials that measured at least one inflammatory biomarker and included adult outpatients with MDD under antidepressant drug therapy (any drug) with or without physical exercise (any modality) were eligible. Results were summarized using the standardized mean difference (SMD) with 95% confidence intervals (95% CI) under a random-effects model. The Cochrane risk of bias tool (2010) was used to evaluate the risk of bias in the included trials.
Sixty-three trials were identified, encompassing data from 3482 patients, and 20 investigated biomarkers. Trials had biases across multiple domains, rising concerns primarily to selection bias/performance bias/detection bias/attrition bias. SMDs between pre- and post-results indicated a significant reduction in the levels of IL-2 (SMD, - 0.25; 95% CI, - 0.41 to - 0.09, P = 0.002), IL-6 (SMD, - 0.19; 95% CI, - 0.35 to - 0.025, P = 0.024), IL-10 (SMD, - 0.32; 95% CI, - 0.57 to - 0.07, P = 0.011), and serum cortisol (SMD, - 0.35; 95% CI, - 0.58 to - 0.12, P = 0.002). Evidence supporting the influence of physical exercise combined with antidepressant drugs on peripheral inflammatory markers in MDD is sparse and heterogeneous.
There is some evidence that antidepressant drug therapy is associated with an overall positive reduction in inflammatory markers, but the evidence is heterogeneous. Further research linking how inflammatory biomarkers modulate physiology related to antidepressant response is required.
CRD42020220735.
对抗抑郁药物治疗（无论是否结合体育锻炼）对重度抑郁症（MDD）患者外周炎症标志物的影响进行系统评价和荟萃分析。
检索MEDLINE、PyscINFO、Embase和谷歌学术数据库至2020年5月。测量了至少一种炎症生物标志物、纳入接受抗抑郁药物治疗（任何药物）无论是否结合体育锻炼（任何形式）的成年门诊MDD患者的随机试验符合要求。采用随机效应模型，使用标准化均数差（SMD）及95%置信区间（95%CI）对结果进行汇总。采用Cochrane偏倚风险工具（2010年版）评估纳入试验的偏倚风险。
共识别出63项试验，涵盖3482例患者的数据，涉及20种生物标志物。试验在多个领域存在偏倚，主要涉及选择偏倚/实施偏倚/检测偏倚/失访偏倚。前后结果之间的标准化均数差表明，白细胞介素-2（IL-2）水平显著降低（SMD，-0.25；95%CI，-0.41至-0.09，P=0.002），白细胞介素-6（IL-6）水平显著降低（SMD，-0.19；95%CI，-0.35至-0.025，P=0.024），白细胞介素-10（IL-10）水平显著降低（SMD，-0.32；95%CI，-0.57至-0.07，P=0.011），血清皮质醇水平显著降低（SMD，-0.35；95%CI，-0.58至-0.12，P=0.002）。支持体育锻炼联合抗抑郁药物对MDD患者外周炎症标志物影响的证据稀少且不一致。
有证据表明抗抑郁药物治疗与炎症标志物总体上呈正向降低相关，但证据不一致。需要进一步研究炎症生物标志物如何调节与抗抑郁反应相关的生理过程。
CRD42020220735。
