抗抑郁药治疗自闭症谱系障碍的整体改善和亚症状的疗效：系统评价和荟萃分析。
Therapeutic effects of antidepressants for global improvement and subdomain symptoms of autism spectrum disorder: a systematic review and meta-analysis.
机构信息
From the Department of Management Centre, Jianan Psychiatric Centre, Ministry Of Health and Welfare, Tainan, Taiwan (Liang); the Centre for General Education, University of Kun Shan, Tainan, Taiwan (Liang); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan (Sun); the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan (Fan, Chung, Cheng); the Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan (Tzang); the Department of Anesthesiology, Chi Mei Medical Centre, Tainan, Taiwan (Hung); the Taoyuan Psychiatric Centre, Ministry of Health and Welfare, Taoyuan City, Taiwan (Chiu); the Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei City, Taiwan (Chiu); the Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung City, Taiwan (Cheng); the Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan (Yeh); Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan (Yeh).
From the Department of Management Centre, Jianan Psychiatric Centre, Ministry Of Health and Welfare, Tainan, Taiwan (Liang); the Centre for General Education, University of Kun Shan, Tainan, Taiwan (Liang); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan (Sun); the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan (Fan, Chung, Cheng); the Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan (Tzang); the Department of Anesthesiology, Chi Mei Medical Centre, Tainan, Taiwan (Hung); the Taoyuan Psychiatric Centre, Ministry of Health and Welfare, Taoyuan City, Taiwan (Chiu); the Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei City, Taiwan (Chiu); the Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung City, Taiwan (Cheng); the Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan (Yeh); Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan (Yeh)
出版信息
J Psychiatry Neurosci. 2022 Aug 10;47(4):E299-E310. doi: 10.1503/jpn.210191. Print 2022 Jul-Aug.
BACKGROUND
No established pharmacological treatment is available for the core symptoms of autism spectrum disorder (ASD). This study aimed at investigating the efficacy of antidepressants for the core and associated symptoms of ASD.
METHODS
We searched PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ScienceDirect, Web of Science and ClinicalTrials.gov using the keywords "ASD" and "antidepressants." We searched from database inception to June 2021 for randomized controlled trials of antidepressant use in patients with ASD. We calculated pooled effect sizes based on a random-effects model.
RESULTS
Analysis of 16 studies with 899 participants showed improvements in restricted and repetitive behaviours (effect size = 0.27) and global symptoms (effect size = 1.0) in patients with ASD taking antidepressants versus those taking placebos ( ≤ 0.01). We found no differences between the 2 groups ( ≥ 0.36) in terms of dropout rate (odds ratio [OR] = 1.17) or rate of study discontinuation because of adverse events (OR = 1.05). We also noted improvements in irritability and hyperactivity in the antidepressant group (Hedges = 0.33 and 0.22, respectively, both < 0.03). Subgroup analyses showed significant effects of medication type (i.e., clomipramine was better than SSRIs) and age (antidepressants were more effective in adults than in children or adolescents) on both restricted and repetitive behaviours and global improvement ( < 0.05). Meta-regression demonstrated that better therapeutic effects were associated with lower symptom severity and older age.
LIMITATIONS
The small effect sizes and variations in treatment response that we found warrant further study.
CONCLUSION
Our results supported the effectiveness of antidepressants for global symptoms and symptom subdomains of ASD, with tolerable adverse effects. Low symptom severity and adulthood were associated with better outcomes.
背景
目前尚无针对自闭症谱系障碍（ASD）核心症状的既定药物治疗方法。本研究旨在调查抗抑郁药治疗 ASD 核心症状和相关症状的疗效。
方法
我们使用“ASD”和“抗抑郁药”等关键词在 PubMed、Embase、ClinicalKey、Cochrane CENTRAL、ScienceDirect、Web of Science 和 ClinicalTrials.gov 上进行了搜索。我们从数据库成立到 2021 年 6 月，搜索了 ASD 患者使用抗抑郁药的随机对照试验。我们基于随机效应模型计算了汇总效应大小。
结果
对 16 项研究（899 名参与者）的分析显示，与安慰剂组相比，服用抗抑郁药的 ASD 患者的受限和重复行为（效应大小=0.27）和总体症状（效应大小=1.0）有所改善（≤0.01）。两组之间在辍学率（优势比[OR]=1.17）或因不良事件而停止研究的比率（OR=1.05）方面无差异（≥0.36）。我们还注意到抗抑郁药组的易怒和多动症状有所改善（Hedges =0.33 和 0.22，均<0.03）。亚组分析表明，药物类型（即氯米帕明优于 SSRIs）和年龄（抗抑郁药在成人中的疗效优于儿童或青少年）对受限和重复行为以及总体改善均有显著影响（<0.05）。元回归表明，更好的治疗效果与较低的症状严重程度和较年长的年龄相关。
局限性
我们发现的小效应量和治疗反应的变化需要进一步研究。
结论
我们的结果支持抗抑郁药治疗 ASD 的总体症状和症状亚领域的有效性，不良反应可耐受。较低的症状严重程度和成年期与更好的结果相关。
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