Wiesinger Teresa, Kremer Stefanie, Bschor Tom, Baethge Christopher
Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany.
Department of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden, Germany.
Acta Psychiatr Scand. 2023 Jun;147(6):545-560. doi: 10.1111/acps.13541. Epub 2023 Mar 20.
Quality of Life (QoL) is an important outcome in mental disorders. We investigated whether antidepressant pharmacotherapy improved QoL vs. placebo among patients with MDD.
Systematic literature search in CENTRAL, Medline, PubMed Central, and PsycINFO of double-blind, placebo-controlled RCTs. Screening, inclusion, extraction, and risk of bias assessment were conducted independently by two reviewers. We calculated summary standardized mean differences (SMD) with 95%-CIs. We followed Cochrane Collaboration's Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF).
We selected 46 RCTs out of 1807 titles and abstracts screened, including 16.171 patients, 9131 on antidepressants and 7040 on placebo, a mean age of 50.9 years, with 64.8% women. Antidepressant drug treatment resulted in a SMD in QoL of 0.22 ([95%-CI: 0.18; 0.26] I 39%) vs. placebo. SMDs differed by indication: 0.38 ([0.29; 0.46] I 0%) in maintenance studies, 0.21 ([0.17; 0.25] I 11%) in acute treatment studies, and 0.11 ([-0.05; 0.26], I 51%) in studies focussing on patients with a physical condition and major depression. There was no indication of subtstantial small study effects, but 36 RCTs had a high or uncertain risk of bias, particularly maintenance trials. QoL and antidepressive effect sizes were associated (Spearman's rho 0.73, p < 0.001).
Antidepressants' effects on QoL are small in primary MDD, and doubtful in secondary major depression and maintenance trials. The strong correlation of QoL and antidepressive effects indicates that the current practice of measuring QoL may not provide sufficient additional insights into the well-being of patients.
生活质量（QoL）是精神障碍的一项重要结果。我们调查了在中度抑郁障碍（MDD）患者中，抗抑郁药物治疗与安慰剂相比是否能改善生活质量。
在CENTRAL、Medline、PubMed Central和PsycINFO中对双盲、安慰剂对照的随机对照试验（RCT）进行系统文献检索。筛选、纳入、提取和偏倚风险评估由两名审阅者独立进行。我们计算了95%置信区间（CI）的汇总标准化均数差（SMD）。我们遵循Cochrane协作网的系统评价和Meta分析手册以及PRISMA指南（在开放科学框架（OSF）上进行方案注册）。
在筛选的1807篇标题和摘要中，我们选择了46项随机对照试验，包括16171名患者，9131名接受抗抑郁药物治疗，7040名接受安慰剂治疗，平均年龄50.9岁，女性占64.8%。与安慰剂相比，抗抑郁药物治疗导致生活质量的标准化均数差为0.22（[95%CI：0.18；0.26]，I² = 39%）。标准化均数差因适应症而异：维持治疗研究中为0.38（[0.29；0.46]，I² = 0%），急性治疗研究中为0.21（[0.17；0.25]，I² = 11%），针对有躯体疾病和重度抑郁患者的研究中为0.11（[-0.05；0.26]，I² = 51%）。没有迹象表明存在实质性的小研究效应，但36项随机对照试验存在高或不确定的偏倚风险，尤其是维持治疗试验。生活质量和抗抑郁效应大小相关（斯皮尔曼等级相关系数为0.73，p < 0.001）。
抗抑郁药物对原发性中度抑郁障碍患者生活质量的影响较小，对继发性重度抑郁和维持治疗试验的影响存疑。生活质量与抗抑郁效应之间的强相关性表明，目前测量生活质量的做法可能无法为患者的幸福感提供足够的额外见解。
