Pastuszak Michał, Cubała Wiesław Jerzy, Jakuszkowiak-Wojten Katarzyna, Kwaśny Aleksander, Świeczkowski Damian, Gałuszko-Węgielnik Maria
Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Department of Toxicology, Faculty of Pharmacy, Medical University of Gdansk, Gdańsk, Poland.
Neuropsychopharmacol Rep. 2025 Mar;45(1):e12519. doi: 10.1002/npr2.12519.
Residual fatigue is a common and debilitating symptom in patients with unipolar and bipolar depression, even after achieving partial or full remission. It significantly impacts patients' quality of life and increases the risk of relapse. This systematic review aims to evaluate the prevalence and effectiveness of therapeutic options for residual fatigue in individuals with unipolar major depressive disorder (MDD) and bipolar disorder (BD).
A comprehensive search was conducted in the PubMed, SCOPUS, and Web of Science databases up to September 2024. The protocol for this systematic review was registered in PROSPERO. The search strategy included terms related to depression and residual fatigue. Studies were included if they provided data on adult patients diagnosed with MDD or BD, and if they measured the prevalence or treatment of residual fatigue. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale for non-randomized studies.
Twenty studies were included in the review. The vast majority reported on MDD, and single papers investigated BD. Residual fatigue was reported by up to 83% of patients, and moderate to severe residual fatigue affected a smaller percentage. Pharmacological treatments, such as modafinil and to a lesser extent atomoxetine, demonstrated short-term reductions in residual fatigue.
Residual fatigue remains a significant challenge in the treatment of depression, persisting in a large portion of patients despite remission. Pharmacological interventions like modafinil appear promising, but more research is needed, especially in BD. Standardized assessment tools and longer-term studies are essential to better understand and treat residual fatigue.
PROSPERO identifier: CRD42024543087.
残余疲劳是单相和双相抑郁症患者常见且使人衰弱的症状，即使在部分或完全缓解后仍会存在。它会显著影响患者的生活质量，并增加复发风险。本系统评价旨在评估单相重度抑郁症（MDD）和双相情感障碍（BD）患者残余疲劳的治疗方法的患病率及有效性。
截至2024年9月，在PubMed、SCOPUS和科学网数据库中进行了全面检索。本系统评价的方案已在PROSPERO中注册。检索策略包括与抑郁症和残余疲劳相关的术语。如果研究提供了关于诊断为MDD或BD的成年患者的数据，并且测量了残余疲劳的患病率或治疗情况，则纳入研究。使用Cochrane随机对照试验（RCT）偏倚风险工具和非随机研究的纽卡斯尔-渥太华量表评估偏倚风险。
本评价纳入了20项研究。绝大多数研究报告的是MDD，仅有一篇论文研究了BD。高达83%的患者报告有残余疲劳，中度至重度残余疲劳影响的比例较小。药物治疗，如莫达非尼以及程度较轻的托莫西汀，显示出能短期减轻残余疲劳。
残余疲劳仍然是抑郁症治疗中的一项重大挑战，尽管病情缓解，但仍有很大一部分患者存在该症状。像莫达非尼这样的药物干预似乎很有前景，但还需要更多研究，尤其是在BD方面。标准化评估工具和长期研究对于更好地理解和治疗残余疲劳至关重要。
PROSPERO标识符：CRD42024543087。
