与抗抑郁药相比，益生菌用于治疗成人重度抑郁症：一项系统评价和网状荟萃分析

Probiotics for adults with major depressive disorder compared with antidepressants: a systematic review and network meta-analysis.

作者信息

Zhao Shilin, Liang Suisha, Tao Jun, Peng Ye, Chen Siqi, Wai Hogan K F, Chung Feng-Ying, Sin Zhen Y, Wong Matthew K L, Haqq Andrea M, Chang Wing C, Ni Michael Y, Chan Francis K L, Ng Siew C, Tun Hein M

机构信息

Microbiota I-Center (MagIC), Hong Kong Special Administrative Region (SAR), China.

Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.

出版信息

Nutr Rev. 2025 Jan 1;83(1):72-82. doi: 10.1093/nutrit/nuad171.

DOI:10.1093/nutrit/nuad171

PMID:38219239

Abstract

CONTEXT

Despite recent advances in antidepressants in treating major depression (MDD), their usage is marred by adverse effects and social stigmas. Probiotics may be an efficacious adjunct or standalone treatment, potentially circumventing the aforementioned issues with antidepressants. However, there is a lack of head-to-head clinical trials between these 2 interventions.

OBJECTIVE

A systematic review and network meta-analysis was conducted to compare the efficacy and acceptability of these 2 interventions in treating MDD.

DATA SOURCES

Six databases and registry platforms for the clinical trial were systematically searched to identify the eligible double-blinded, randomized controlled trials published between 2015 and 2022.

DATA EXACTION

Two authors selected independently the placebo-controlled trials of antidepressants and microbiota-targeted interventions (prebiotics, probiotics, and synbiotics) used for the treatment of MDD in adults (≥18 years old). Standardized mean differences (SMDs) of depressive symptom scores from individual trials were pooled for network meta-analysis (PROSPERO no. CRD42020222305).

RESULTS

Forty-two eligible trials covering 22 interventions were identified, of which 16 were found to be effective in MDD treatment and the certainty of evidence was moderate to very low. When all trials were considered, compared with placebo, SMDs of interventions ranged from -0.16 (95% credible interval: -0.30, -0.04) for venlafaxine to -0.81 (-1.06, -0.52) for escitalopram. Probiotics were superior to brexpiprazole (SMD [95% credible interval]: -0.42 [-0.68, -0.17]), cariprazine (-0.44 [-0.69, -0.24]), citalopram (-0.37 [-0.66, -0.07]), duloxetine (-0.26, [-0.51, -0.04]), desvenlafaxine (-0.38 [-0.63, -0.14]), ketamine (-0.32 [-0.66, -0.01]), venlafaxine (-0.47 [-0.73, -0.23]), vilazodone (-0.37 [-0.61, -0.12]), vortioxetine (-0.39 [-0.63, -0.15]), and placebo (-0.62 [-0.86, -0.42]), and were noninferior to other antidepressants. In addition, probiotics ranked the second highest in the treatment hierarchy after escitalopram. Long-term treatment (≥8 weeks) using probiotics showed the same tolerability as antidepressants.

CONCLUSION

Probiotics, compared with antidepressants and placebo, may be efficacious as an adjunct or standalone therapy for treating MDD.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020222305.

摘要

背景

尽管近期抗抑郁药在治疗重度抑郁症（MDD）方面取得了进展，但其使用受到不良反应和社会污名的影响。益生菌可能是一种有效的辅助或独立治疗方法，有可能规避抗抑郁药的上述问题。然而，这两种干预措施之间缺乏直接比较的临床试验。

目的

进行一项系统评价和网状Meta分析，以比较这两种干预措施在治疗MDD方面的疗效和可接受性。

数据来源

系统检索了六个临床试验数据库和注册平台，以识别2015年至2022年期间发表的符合条件的双盲、随机对照试验。

数据提取

两位作者独立选择了用于治疗成人（≥18岁）MDD的抗抑郁药和针对微生物群的干预措施（益生元、益生菌和合生元）的安慰剂对照试验。将各个试验中抑郁症状评分的标准化均值差（SMD）汇总用于网状Meta分析（国际前瞻性系统评价注册库编号：CRD42020222305）。

结果

共识别出42项符合条件的试验，涵盖22种干预措施，其中16种被发现对MDD治疗有效，证据的确定性为中等至非常低。当考虑所有试验时，与安慰剂相比，干预措施的SMD范围从文拉法辛的-0.16（95%可信区间：-0.30，-0.04）到艾司西酞普兰的-0.81（-1.06，-0.52）。益生菌优于布雷哌唑（SMD[95%可信区间]：-0.42[-0.68，-0.17]）、卡立普唑（-0.44[-0.69，-0.24]）、西酞普兰（-0.37[-0.66，-0.07]）、度洛西汀（-0.26，[-0.51，-0.04]）、去甲文拉法辛（-0.38[-0.63，-0.14]）、氯胺酮（-0.32[-0.66，-0.01]）、文拉法辛（-0.47[-0.73，-0.23]）、维拉唑酮（-0.37[-0.61，-0.12]）、伏硫西汀（-0.39[-0.63，-0.15]）和安慰剂（-0.62[-0.86，-0.42]），且不劣于其他抗抑郁药。此外，益生菌在治疗等级中仅次于艾司西酞普兰，排名第二。使用益生菌进行长期治疗（≥8周）显示出与抗抑郁药相同的耐受性。