{"title":"Orexin Receptor Antagonists as Adjunct Drugs for the Treatment of Depression: A Mini Meta-Analysis.","authors":"Mustafa Uğurlu","doi":"10.29399/npa.28383","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>There is growing interest in the efficacy of orexin receptor antagonists (ORA), one of the new psychopharmacological agents used in the treatment of insomnia, in other psychiatric disorders such as depression.</p><p><strong>Methods: </strong>This meta-analysis was conducted in accordance with PRISMA requirements. Literature searches were conducted using PubMed, Scopus and EBSCO (Medline) databases. Search words were (depression OR mood disorder OR affective disorder) AND (orexin OR orx OR hypocretin OR orx1 OR orx2 OR orexin receptor antagonist OR almorexant OR suvorexant OR lemborexant OR daridorexant OR seltorexant OR vornorexant OR filorexant). No date restrictions were used. The random effects model was used for analyses with I<sup>2</sup> values above 50% and fixed effects model was used for analyses with I<sup>2</sup> values below 50%.</p><p><strong>Results: </strong>In the acute phase, ORAs had no significant effect on core, sleep-adjusted and total symptoms of depression respectively; Standardized Mean Difference (SMD) for random effect -0.422, 95% CI [-0.90; 0.06], p=0.089, I<sup>2</sup>=62.4%; SMD for random effect -0.375, 95% CI [-1.24; 0.49], p=0.400; I<sup>2</sup>=66.6% and SMD for random effect -0.477, 95% CI [-0.97; 0.01], p=0.059; I<sup>2</sup>=83.1%). However, they had a significant effect on core and total symptoms of depression in the early period respectively; SMD for fixed effect=-0.228, 95% CI [-0.44; -0.01], p=0.036, I<sup>2</sup>=9.1%; and SMD for fixed effect=-0.186, 95% CI [-0.37; -0.001], p=0.048, I<sup>2</sup>=0.0%, respectively).</p><p><strong>Conclusion: </strong>The results of this meta-analysis suggest that ORAs may provide direct antidepressant efficacy when added to existing antidepressant treatment and may also have indirect antidepressant effects through improvement in sleep symptoms. Considering the physiological effects of orexin on behaviors, ORAs may be promising new treatment modalities in the treatment of many psychiatric disorders other than insomnia. However, these results are preliminary and further studies with different ORAs at different doses and with different samples are needed.</p>","PeriodicalId":51142,"journal":{"name":"Noropsikiyatri Arsivi-Archives of Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":1.0000,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10943935/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Noropsikiyatri Arsivi-Archives of Neuropsychiatry","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.29399/npa.28383","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: There is growing interest in the efficacy of orexin receptor antagonists (ORA), one of the new psychopharmacological agents used in the treatment of insomnia, in other psychiatric disorders such as depression.
Methods: This meta-analysis was conducted in accordance with PRISMA requirements. Literature searches were conducted using PubMed, Scopus and EBSCO (Medline) databases. Search words were (depression OR mood disorder OR affective disorder) AND (orexin OR orx OR hypocretin OR orx1 OR orx2 OR orexin receptor antagonist OR almorexant OR suvorexant OR lemborexant OR daridorexant OR seltorexant OR vornorexant OR filorexant). No date restrictions were used. The random effects model was used for analyses with I2 values above 50% and fixed effects model was used for analyses with I2 values below 50%.
Results: In the acute phase, ORAs had no significant effect on core, sleep-adjusted and total symptoms of depression respectively; Standardized Mean Difference (SMD) for random effect -0.422, 95% CI [-0.90; 0.06], p=0.089, I2=62.4%; SMD for random effect -0.375, 95% CI [-1.24; 0.49], p=0.400; I2=66.6% and SMD for random effect -0.477, 95% CI [-0.97; 0.01], p=0.059; I2=83.1%). However, they had a significant effect on core and total symptoms of depression in the early period respectively; SMD for fixed effect=-0.228, 95% CI [-0.44; -0.01], p=0.036, I2=9.1%; and SMD for fixed effect=-0.186, 95% CI [-0.37; -0.001], p=0.048, I2=0.0%, respectively).
Conclusion: The results of this meta-analysis suggest that ORAs may provide direct antidepressant efficacy when added to existing antidepressant treatment and may also have indirect antidepressant effects through improvement in sleep symptoms. Considering the physiological effects of orexin on behaviors, ORAs may be promising new treatment modalities in the treatment of many psychiatric disorders other than insomnia. However, these results are preliminary and further studies with different ORAs at different doses and with different samples are needed.
简介:奥曲肽受体拮抗剂(ORA)是用于治疗失眠症的新型精神药物之一,其对抑郁症等其他精神疾病的疗效日益受到关注:本荟萃分析按照 PRISMA 要求进行。使用 PubMed、Scopus 和 EBSCO(Medline)数据库进行文献检索。检索词为(抑郁症或心境障碍或情感障碍)和(奥曲肽或奥曲肽或视网膜下素或奥曲肽1或奥曲肽2或奥曲肽受体拮抗剂或almorexant或suvorexant或lemborexant或daridorexant或seltorexant或vornorexant或filorexant)。没有使用日期限制。I2值高于50%的分析采用随机效应模型,I2值低于50%的分析采用固定效应模型:结果:在急性期,ORAs分别对核心抑郁症状、睡眠调整抑郁症状和总抑郁症状没有显著影响;随机效应的标准化平均差(SMD)为-0.422,95% CI [-0.90;0.06],p=0.089,I2=62.4%;随机效应的SMD为-0.375,95% CI [-1.24;0.49],p=0.400;I2=66.6%和随机效应的SMD为-0.477,95% CI [-0.97;0.01],p=0.059;I2=83.1%)。然而,它们分别对早期的核心抑郁症状和总体抑郁症状有显著影响;固定效应的SMD=-0.228,95% CI [-0.44;-0.01],P=0.036,I2=9.1%;固定效应的SMD=-0.186,95% CI [-0.37;-0.001],P=0.048,I2=0.0%):这项荟萃分析的结果表明,在现有抗抑郁治疗的基础上加入ORAs,可能会产生直接的抗抑郁疗效,还可能通过改善睡眠症状产生间接的抗抑郁效果。考虑到奥曲肽对行为的生理影响,奥曲肽可能是治疗失眠以外的多种精神疾病的一种很有前景的新治疗方式。不过,这些结果只是初步的,还需要对不同剂量和不同样本的奥曲肽进行进一步研究。
期刊介绍:
Archives of Neuropsychiatry (Arch Neuropsychiatry) is the official journal of the Turkish Neuropsychiatric Society. It is published quarterly, and four editions annually constitute a volume.
Archives of Neuropsychiatry is a peer reviewed scientific journal that publishes articles on psychiatry, neurology, and behavioural sciences. Both clinical and basic science contributions are welcomed. Submissions that address topics in the interface of neurology and psychiatry are encouraged. The content covers original research articles, reviews, letters to the editor, and case reports.