Bossola Maurizio, Mariani Ilaria, Antocicco Manuela, Pepe Gilda, Petrosino Anna, Di Stasio Enrico
Servizio Emodialisi, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Policlinico Universitario Fondazione Agostino Gemelli IRCCS, 00168 Rome, Italy.
J Clin Med. 2024 Jun 5;13(11):3334. doi: 10.3390/jcm13113334.
The use of selective serotonin reuptake inhibitors (SSRIs) is common among hemodialysis patients who receive treatment for depression. However, studies on the efficacy of SSRIs in patients on chronic hemodialysis are few and have led to conflicting results. The present systematic review aims to evaluate, in randomized, controlled studies (RCSs), the efficacy of SSRI administration in reducing symptoms of depression in patients on chronic hemodialysis when compared with placebo or psychological interventions. : Research was run on December 2023 in the following databases: Ovid MEDLINE (1985 to present); Ovid EMBASE (1985 to present); Cochrane Library (Wiley); and PubMed (1985 to present). The primary outcome was the frequency and severity of the symptoms of depression assessed through the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HAMD). The secondary outcome was the prevalence of adverse events. : Seven studies totaling 433 patients were included. The number of patients in each individual study ranged from 13 to 120. The length of studies ranged from 8 weeks to 6 months. Heterogeneous data precluded informative meta-analysis. Three studies compared sertraline with a placebo. Of these, two demonstrated that sertraline was better than the placebo in reducing the symptoms of depression while one showed no statistically significant differences between sertraline and the placebo. One study, comparing fluoxetine with a placebo showed that the symptoms of depression did not differ significantly at 8 weeks. In another study, escitalopram administration led to a significantly greater reduction in the Hamilton Depression Rating Scale score compared to a placebo, as well as in the Hamilton Anxiety Rating Scale score. In one study, citalopram and psychological interventions were both effective in reducing the symptoms of depression and anxiety and, in another study, sertraline was modestly more effective than CBT at 12 weeks in reducing the symptoms of depression. : SSRIs may be effective in reducing the symptoms of depression in patients on chronic hemodialysis. SSRI administration, at the dosage used in the studies included in the present systematic review, seems safe in most hemodialysis patients. However, the paucity of studies and the limited number of patients included in the trials may suggest that further randomized, controlled studies are needed to determine if SSRIs may be used routinely in daily clinical practice in such a population.
对于患有抑郁症且接受治疗的血液透析患者而言，选择性5-羟色胺再摄取抑制剂（SSRI）的使用较为普遍。然而，关于SSRI对慢性血液透析患者疗效的研究较少，且结果相互矛盾。本系统评价旨在通过随机对照研究（RCS），评估与安慰剂或心理干预相比，给予SSRI对慢性血液透析患者抑郁症状的缓解效果。2023年12月在以下数据库进行了检索：Ovid MEDLINE（1985年至今）；Ovid EMBASE（1985年至今）；Cochrane图书馆（Wiley）；以及PubMed（1985年至今）。主要结局是通过贝克抑郁量表（BDI）或汉密尔顿抑郁评定量表（HAMD）评估的抑郁症状的频率和严重程度。次要结局是不良事件的发生率。纳入了7项研究，共433例患者。每项研究的患者数量从13例至120例不等。研究时长从8周至6个月不等。数据的异质性使得无法进行有效的荟萃分析。3项研究将舍曲林与安慰剂进行了比较。其中，2项研究表明舍曲林在减轻抑郁症状方面优于安慰剂，而1项研究显示舍曲林与安慰剂之间无统计学显著差异。1项将氟西汀与安慰剂进行比较的研究表明，8周时抑郁症状无显著差异。在另一项研究中，与安慰剂相比，给予艾司西酞普兰导致汉密尔顿抑郁评定量表评分以及汉密尔顿焦虑评定量表评分显著降低。在1项研究中，西酞普兰和心理干预在减轻抑郁和焦虑症状方面均有效，而在另一项研究中，12周时舍曲林在减轻抑郁症状方面比认知行为疗法（CBT）略更有效。SSRI可能对减轻慢性血液透析患者的抑郁症状有效。在本系统评价纳入的研究中所使用的剂量下给予SSRI，在大多数血液透析患者中似乎是安全的。然而，研究数量较少且试验纳入的患者数量有限，这可能表明需要进一步的随机对照研究来确定SSRI是否可在此类人群的日常临床实践中常规使用。
