Terao Itsuki, Kodama Wakako
Department of Psychiatry Ikokoro Clinic Nihonbashi Chuo-ku Japan.
Department of Psychiatry Negishi Hospital Fuchu-shi Japan.
PCN Rep. 2024 Dec 4;3(4):e70042. doi: 10.1002/pcn5.70042. eCollection 2024 Dec.
The individual efficacy and safety of intravenous racemic (IV) ketamine, psilocybin, and theta burst stimulation (TBS) for major depressive disorder have been demonstrated through meta-analyses of randomized controlled trials (RCTs), but the comparative usefulness of these novel treatments has not yet been fully examined. We systematically searched the CENTRAL, Medline, CINHAL, and ClinicalTrials.gov databases for randomized controlled trials up to July 4, 2024. Random-effects network meta-analyses were conducted to compare the Comparative antidepressant effects and safety of intravenous racemic ketamine, psilocybin and theta burst stimulation for major depressive disorderantidepressant efficacy, tolerability, and acceptability of IV ketamine, psilocybin, and TBS. Twenty-eight RCTs were included. All treatments were superior to placebo, with IV ketamine and psilocybin showing significantly greater antidepressant efficacy than TBS. No significant differences were detected between all treatments and placebo in tolerability and acceptability. In a subgroup analysis focusing on short periods of 1 week or less, only IV ketamine was significantly more effective than placebo. In another subgroup analysis focusing on periods of 4 weeks or longer, IV ketamine and psilocybin showed significantly better antidepressant effects than placebo. The confidence in the evidence ranged from very low to moderate. Specifically, there is a scarcity of studies on psilocybin and a lack of direct comparison trials. The findings suggest that IV ketamine and psilocybin may be more effective treatments compared to TBS. Additionally, IV ketamine may have an advantage in terms of rapid onset of action. The number of included studies is limited, especially for psilocybin, and therefore the current findings are preliminary, necessitating further accumulation of direct-comparison RCTs.
通过对随机对照试验（RCT）的荟萃分析，已证明静脉注射消旋氯胺酮（IV）、裸盖菇素和theta波爆发刺激（TBS）治疗重度抑郁症的个体疗效和安全性，但这些新疗法的相对有效性尚未得到充分研究。我们系统检索了截至2024年7月4日的CENTRAL、Medline、CINHAL和ClinicalTrials.gov数据库中的随机对照试验。进行随机效应网络荟萃分析，以比较静脉注射消旋氯胺酮、裸盖菇素和theta波爆发刺激治疗重度抑郁症的抗抑郁效果、耐受性和可接受性。纳入了28项随机对照试验。所有治疗均优于安慰剂，静脉注射氯胺酮和裸盖菇素的抗抑郁疗效显著高于TBS。在耐受性和可接受性方面，所有治疗与安慰剂之间未检测到显著差异。在一项针对1周或更短时间的亚组分析中，只有静脉注射氯胺酮比安慰剂显著更有效。在另一项针对4周或更长时间的亚组分析中，静脉注射氯胺酮和裸盖菇素的抗抑郁效果显著优于安慰剂。证据的可信度从非常低到中等不等。具体而言，关于裸盖菇素的研究较少，且缺乏直接比较试验。研究结果表明，与TBS相比，静脉注射氯胺酮和裸盖菇素可能是更有效的治疗方法。此外，静脉注射氯胺酮在起效速度方面可能具有优势。纳入研究的数量有限，尤其是关于裸盖菇素的研究，因此目前的研究结果是初步的，需要进一步积累直接比较的随机对照试验。
