Department of Graduate School, Shandong First Medical University (Shandong Academy of Medical Science), Jinan, 250117, Shandong, China.
Internal Medicine, People's Hospital of Sishui County, Sishui, 273200, Shandong, China.
Clin Drug Investig. 2024 Jul;44(7):459-469. doi: 10.1007/s40261-024-01378-8. Epub 2024 Jul 3.
Although selective serotonin reuptake inhibitors (SSRIs) are usually considered safe to use in patients with Parkinson's disease (PD), there are mixed data about their effectiveness, and only a few investigations have led to a total improvement of depressive symptoms in patients with PD.
We aimed to conduct a comprehensive systematic review and meta-analysis of all studies that investigated the effectiveness of SSRIs in treating depression in the context of PD.
From its commencement to June 2024, the databases of MEDLINE via PubMed, Scopus, Embase, and Google Scholar were electronically searched for the relevant papers. All full-text journal articles assessing the effectiveness of SSRIs in treating depression in patients with PD were included. The tool developed by the Cochrane Collaboration was utilized to evaluate the bias risk. Data were analyzed utilizing a pair-wise comparison meta-analysis using the standardized mean difference.
A total of 19 articles and 22 separate interventions were included. We found that SSRI treatment attenuated depression in patients with PD (1.242 standardized mean difference, 95% confidence interval 0.956, 1.529, p < 0.001). The general heterogeneity of the studies was medium (ϰ = 72.818, T = 0.317, df = 21, I = 71.15%, p < 0.001). The funnel plot was reasonably symmetrical. However, three studies were trimmed to the left of the mean. Begg's test (p = 0.080), Egger's test (p = 0.121), and funnel plot showed no significant risk of publication bias. The meta-regression showed that the treatment effect increased as a function of paroxetine treatment duration (slope p = 0.001) but decreased as a function of sertraline treatment duration (slope p = 0.019).
There are few controlled antidepressant trials on the PD population, even though patients with PD frequently experience depression and use antidepressants. Clinical studies that are larger and better structured are needed in the future to determine if antidepressants are useful for treating patients with PD with depression.
尽管选择性 5-羟色胺再摄取抑制剂（SSRIs）通常被认为在帕金森病（PD）患者中使用是安全的，但关于其疗效的数据却存在差异，只有少数研究导致 PD 患者的抑郁症状得到全面改善。
我们旨在对所有研究进行全面的系统评价和荟萃分析，以调查 SSRIs 在治疗 PD 患者抑郁中的疗效。
从开始到 2024 年 6 月，通过 PubMed 中的 MEDLINE、Scopus、Embase 和 Google Scholar 电子搜索相关文献。纳入评估 SSRIs 治疗 PD 患者抑郁的有效性的所有全文期刊文章。使用 Cochrane 协作组开发的工具评估偏倚风险。使用标准化均数差的成对比较荟萃分析来分析数据。
共纳入 19 篇文章和 22 项单独干预措施。我们发现 SSRI 治疗可减轻 PD 患者的抑郁（1.242 标准化均数差，95%置信区间 0.956，1.529，p<0.001）。研究的总体异质性为中等（κ=72.818，T=0.317，df=21，I=71.15%，p<0.001）。漏斗图基本对称。然而，有 3 项研究的均值向左修剪。Begg 检验（p=0.080）、Egger 检验（p=0.121）和漏斗图均未显示出显著的发表偏倚风险。元回归显示，治疗效果随帕罗西汀治疗持续时间的增加而增加（斜率 p=0.001），但随舍曲林治疗持续时间的增加而降低（斜率 p=0.019）。
尽管 PD 患者经常出现抑郁并使用抗抑郁药，但针对 PD 人群的抗抑郁药物对照试验很少。未来需要进行更大规模和更具结构性的临床研究，以确定抗抑郁药是否对治疗 PD 伴抑郁的患者有用。
