Hirschbeck Anna, Leao Douglas Silva, Wagner Elias, Hasan Alkomiet, Roeh Astrid
Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany.
Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
Front Psychiatry. 2022 Sep 6;13:985983. doi: 10.3389/fpsyt.2022.985983. eCollection 2022.
The impact of psychiatric medications and their enhancing or impairing effects on physical performance remains inconclusive. Therefore, with this systematic review we provide a comprehensive overview of frequently used psychotropic drugs and their effects on physical performance for the purpose of providing empirical information and deriving prescription and therapy recommendations for clinical practice.
We systematically searched PubMed, PsycInfo, and Cochrane databases and extracted human studies investigating the effect of psychotropic drugs on parameters associated with the level of physical performance, such as exercise time, oxygen consumption, heart rate, muscle contraction or blood lactate concentration in physically healthy participants. 36 studies - comprising a broad range of psychotropic agents, such as antidepressants, antipsychotics, sedatives, and stimulants - were selected for final analyses.
Most studies ( = 32) were randomized controlled trials (RCT) with a double-blind crossover design. Antidepressants ( = 21) were the most frequently studied drug class, with contradictory results e.g., performance enhancement in warm environment but not in temperate conditions for bupropion or inconsistent findings between studies for other antidepressants. Antipsychotics ( = 3) mainly showed impairing effects on physical performance, while stimulants ( = 4) were often performance-enhancing. Sedatives ( = 9) may cause a hangover effect.
The examined studies with heterogeneous design showed different effects of psychiatric medications on physical performance. Antipsychotics seemed to be performance impairing, while the findings for antidepressants and sedatives were more inconsistent. Stimulants were the only group with consistent performance-enhancing effects. However, most studies were conducted with a small sample size ( < 10), mostly in well-trained subjects rather than in patients with psychiatric disorders, and most studies used single-dose designs. These issues impede the formulation of generalized conclusions for treatment regimes and should therefore be considered in further longitudinal studies for clinically reliable statements. Nevertheless, answering our research question is quite relevant for clinical practice and therapeutic prescription and should be further investigated especially considering the high drop-out rates in drug treatment.
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=276103], identifier [CRD42021276103].
精神科药物对身体机能的增强或损害作用尚无定论。因此，通过本系统评价，我们全面概述了常用精神药物及其对身体机能的影响，旨在提供实证信息，并为临床实践得出处方和治疗建议。
我们系统检索了PubMed、PsycInfo和Cochrane数据库，并提取了关于精神药物对身体健康参与者与身体机能水平相关参数（如运动时间、耗氧量、心率、肌肉收缩或血乳酸浓度）影响的人体研究。最终分析选取了36项研究，这些研究涵盖了广泛的精神药物，如抗抑郁药、抗精神病药、镇静剂和兴奋剂。
大多数研究（n = 32）为随机对照试验（RCT），采用双盲交叉设计。抗抑郁药（n = 21）是研究最频繁的药物类别，结果相互矛盾，例如安非他酮在温暖环境中可提高身体机能，但在温带条件下则不然，其他抗抑郁药在不同研究中的结果也不一致。抗精神病药（n = 3）主要显示出对身体机能的损害作用，而兴奋剂（n = 4）通常可提高身体机能。镇静剂（n = 9）可能会导致宿醉效应。
设计各异的研究表明，精神科药物对身体机能有不同影响。抗精神病药似乎会损害身体机能，而抗抑郁药和镇静剂的研究结果则更不一致。兴奋剂是唯一一组具有一致身体机能增强作用的药物。然而，大多数研究样本量较小（n < 10），主要针对训练有素的受试者而非精神疾病患者，且大多数研究采用单剂量设计。这些问题阻碍了对治疗方案得出一般性结论，因此在进一步的纵向研究中应予以考虑，以得出临床可靠的结论。尽管如此，回答我们的研究问题与临床实践和治疗处方密切相关，尤其考虑到药物治疗中的高脱落率，应进一步开展研究。
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=276103]，标识符[CRD42021276103]
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