Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria, and Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands (L.A.).
Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria (G.W., A.D., A.T., A.C., E.P., I.K.).
Ann Intern Med. 2023 Feb;176(2):217-223. doi: 10.7326/M22-1900. Epub 2023 Jan 24.
Developers of clinical practice guidelines need to take patient values and preferences into consideration when weighing benefits and harms of treatment options for depressive disorder.
To assess patient values and preferences regarding pharmacologic and nonpharmacologic treatments of depressive disorder.
MEDLINE (Ovid) and PsycINFO (EBSCO) were searched for eligible studies published from 1 January 2014 to 30 November 2022.
Pairs of reviewers independently screened 30% of search results. The remaining 70% of the abstracts were screened by single reviewers; excluded abstracts were checked by a second reviewer. Pairs of reviewers independently screened full texts.
One reviewer extracted data and assessed the certainty of evidence, and a second reviewer checked for completeness and accuracy. Two reviewers independently assessed risk of bias.
The review included 11 studies: 4 randomized controlled trials, 5 cross-sectional studies, and 2 qualitative studies. In 1 randomized controlled trial, participants reported at the start of therapy that they expected supportive-expressive psychotherapy and antidepressants to yield similar improvements. A cross-sectional study reported that non-Hispanic White participants and men generally preferred antidepressants over talk therapy, whereas Hispanic and non-Hispanic Black participants and women generally did not have a preference. Another cross-sectional study reported that the most important nonserious adverse events for patients treated with antidepressants were insomnia, anxiety, fatigue, weight gain, agitation, and sexual dysfunction. For other comparisons and outcomes, no conclusions could be drawn because of the insufficient certainty of evidence.
The main limitation of this review is the low or insufficient certainty of evidence for most outcomes. No evidence was available on second-step depression treatment or differences in values and preferences based on gender, race/ethnicity, age, and depression severity.
Low-certainty evidence suggests that there may be some differences in preferences for talk therapy or pharmacologic treatment of depressive disorders based on gender or race/ethnicity. In addition, low-certainty evidence suggests that insomnia, anxiety, fatigue, weight gain, agitation, and sexual dysfunction may be the most important nonserious adverse events for patients treated with antidepressants. Evidence is lacking or insufficient to draw any further conclusions about patients' weighing or valuation of the benefits and harms of depression treatments.
American College of Physicians. (PROSPERO: CRD42020212442).
在权衡抑郁障碍治疗选择的获益和危害时，临床实践指南的制定者需要考虑患者的价值观和偏好。
评估患者对抑郁障碍药物和非药物治疗的价值观和偏好。
检索了 MEDLINE（Ovid）和 PsycINFO（EBSCO）自 2014 年 1 月 1 日至 2022 年 11 月 30 日发表的合格研究。
两名评审员独立筛选了 30%的检索结果。其余 70%的摘要由单名评审员筛选；排除的摘要由第二名评审员检查。两名评审员独立筛选全文。
一名评审员提取数据并评估证据的确定性，第二名评审员检查完整性和准确性。两名评审员独立评估偏倚风险。
本综述纳入了 11 项研究：4 项随机对照试验、5 项横断面研究和 2 项定性研究。在一项随机对照试验中，参与者在开始治疗时报告称，他们预计支持性表达心理治疗和抗抑郁药会产生类似的改善。一项横断面研究报告称，非西班牙裔白人和男性通常更喜欢抗抑郁药而不是谈话疗法，而西班牙裔和非西班牙裔黑人和女性通常没有偏好。另一项横断面研究报告称，接受抗抑郁药治疗的患者最关心的非严重不良事件是失眠、焦虑、疲劳、体重增加、烦躁不安和性功能障碍。对于其他比较和结果，由于证据的确定性低或不足，无法得出结论。
本综述的主要局限性是大多数结果的证据确定性低或不足。没有关于第二步抑郁治疗或基于性别、种族/民族、年龄和抑郁严重程度的价值观和偏好差异的证据。
低确定性证据表明，基于性别或种族/民族，对抑郁障碍的谈话疗法或药物治疗的偏好可能存在一些差异。此外，低确定性证据表明，失眠、焦虑、疲劳、体重增加、烦躁不安和性功能障碍可能是接受抗抑郁药治疗的患者最关心的非严重不良事件。关于患者对抑郁治疗的获益和危害的权衡或评估，证据不足或缺乏。
美国医师学院（PROSPERO：CRD42020212442）。
