Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China.
Eur J Pharmacol. 2022 Jul 15;927:175070. doi: 10.1016/j.ejphar.2022.175070. Epub 2022 Jun 1.
Depressive symptom is the prevailing non-motor symptom of Parkinson's disease (PD). Drug treatments for depressed PD (dPD) can mitigate the symptoms of patients. However, the results are discordant and need further analysis. This systematic review with network meta-analysis aims to evaluate the drug treatments for dPD. We included double-blind, randomized controlled trials to compare antidepressants with placebo or other antidepressants in dPD. We performed traditional pairwise analysis and network meta-analysis concerning the efficacy, acceptability, depression score, and adverse effect. The surface under the cumulative ranking curve was to assess the ranking probabilities of the enrolled agents. We enrolled 62 studies, including 12,353 subjects, to analyze these estimates. For the traditional pairwise meta-analysis, dopamine agonist (DOP; OR = 2.20 [95% CI, 1.46 to 3.33]) and selective serotonin reuptake inhibitor (SSRI; OR = 2.30 [95% CI, 1.15 to 4.60]) were observed to improve the efficacy compared with placebo. For network meta-analysis, DOP was observed to improve the efficacy compared with placebo (OR = -0.84 [95% CI, -1.20 to -0.48]). Both direct and indirect evidence showed that several treatments, e.g., DOP, monoamine-oxidase inhibitor, serotonin-norepinephrine reuptake inhibitors, SSRI, and tricyclic antidepressants, significantly improved depressive symptoms. DOP and SSRI had good efficacy and improved symptoms considerably in dPD, but the adverse effect of these agents was needed to follow closely.
抑郁症状是帕金森病（PD）的主要非运动症状。治疗抑郁型 PD（dPD）的药物可以减轻患者的症状。然而，结果并不一致，需要进一步分析。本系统评价结合网络荟萃分析旨在评估治疗 dPD 的药物。我们纳入了比较抗抑郁药与安慰剂或其他抗抑郁药治疗 dPD 的双盲、随机对照试验。我们进行了传统的两两分析和网络荟萃分析，以评估疗效、可接受性、抑郁评分和不良反应。累积排序曲线下面积用于评估纳入药物的排名概率。我们共纳入 62 项研究，包括 12353 名受试者，对这些数据进行分析。对于传统的两两荟萃分析，与安慰剂相比，多巴胺激动剂（DOP；OR=2.20 [95% CI，1.46-3.33]）和选择性 5-羟色胺再摄取抑制剂（SSRIs；OR=2.30 [95% CI，1.15-4.60]）被观察到能提高疗效。对于网络荟萃分析，DOP 与安慰剂相比能提高疗效（OR=-0.84 [95% CI，-1.20 至 -0.48]）。直接和间接证据均表明，DOP、单胺氧化酶抑制剂、去甲肾上腺素和 5-羟色胺再摄取抑制剂、SSRIs 和三环类抗抑郁药等多种治疗方法可显著改善抑郁症状。DOP 和 SSRI 对 dPD 有良好的疗效，能显著改善症状，但需要密切关注这些药物的不良反应。
