Kearns Benjamin, Cooper Katy, Orr Martin, Essat Munira, Hamilton Jean, Cantrell Anna
School of Health and Related Research (SCHARR), the University of Sheffield, Sheffield, UK.
Neuropsychiatr Dis Treat. 2022 Jun 7;18:1133-1143. doi: 10.2147/NDT.S356414. eCollection 2022.
There is variation in the safety profile of antidepressants. Rates of adverse events along with the costs of treating them can be an important factor influencing the choice of depression treatment. This study sought to estimate the comparative safety of commonly prescribed antidepressants, and how the costs of treating these varied across European countries.
A systematic literature review was conducted (in Medline, Embase, PsycINFO and CENTRAL) to identify placebo-controlled trials reporting rates of at least one type of sexual dysfunction, weight change, insomnia, anxiety, and anhedonia. Eight antidepressants were considered: duloxetine, escitalopram, fluoxetine, paroxetine, sertraline, trazodone, venlafaxine, and vortioxetine. This evidence was synthesised via Bayesian random effects network meta-analyses to provide comparative estimates of safety. A systematic search identified country-specific costs of managing depression and adverse events of antidepressants. Evidence on costs and safety was combined in an economic model to provide country-specific costs for Bulgaria, the Czech Republic, Greece, Hungary, Italy, Romania, Slovakia, Portugal, and Poland.
Trazodone had the lowest rates of both insomnia (odds ratio 0.66, 95% credible interval 0.31 to 1.38) and anxiety (0.13, <0.01 to 1.80). All antidepressants were associated with increased rates of sexual dysfunction relative to placebo. Weight change was largest for fluoxetine (kg change -1.01, -1.40 to -0.60) and sertraline (-1.00, -1.36 to -0.65), although heterogeneity was extreme for this outcome. No evidence was identified for anhedonia. Total costs were lowest for trazodone in all nine of the countries evaluated. This was primarily due to reduced rates of treatment discontinuation.
Trazodone generally had the best safety profile of the antidepressants evaluated. This led to healthcare costs being lowest for trazodone in all nine European countries, emphasising the importance of considering rates of adverse events when choosing a pharmacological treatment to treat symptoms of depression.
抗抑郁药的安全性存在差异。不良事件发生率及其治疗成本可能是影响抑郁症治疗选择的重要因素。本研究旨在评估常用抗抑郁药的相对安全性，以及在欧洲各国治疗这些疾病的成本差异。
进行了一项系统的文献综述（检索Medline、Embase、PsycINFO和CENTRAL），以确定报告至少一种性功能障碍、体重变化、失眠、焦虑和快感缺失发生率的安慰剂对照试验。考虑了八种抗抑郁药：度洛西汀、艾司西酞普兰、氟西汀、帕罗西汀、舍曲林、曲唑酮、文拉法辛和伏硫西汀。通过贝叶斯随机效应网络荟萃分析对这些证据进行综合，以提供安全性的比较估计。系统检索确定了各国治疗抑郁症和抗抑郁药不良事件的特定成本。在一个经济模型中结合成本和安全性证据，以提供保加利亚、捷克共和国、希腊、匈牙利、意大利、罗马尼亚、斯洛伐克、葡萄牙和波兰的特定国家成本。
曲唑酮的失眠（比值比0.66，95%可信区间0.31至1.38）和焦虑（0.13，<0.01至1.80）发生率最低。与安慰剂相比，所有抗抑郁药的性功能障碍发生率均有所增加。氟西汀（体重变化-1.01，-1.40至-0.60）和舍曲林（-1.00，-1.36至-0.65）的体重变化最大，尽管该结果的异质性极高。未发现有关快感缺失的证据。在所有九个评估国家中，曲唑酮的总成本最低。这主要是由于治疗中断率降低。
在所评估的抗抑郁药中，曲唑酮总体安全性最佳。这使得曲唑酮在所有九个欧洲国家的医疗保健成本最低，强调了在选择治疗抑郁症症状的药物时考虑不良事件发生率的重要性。
