重度抑郁症患者的抗抑郁药和社会功能:双盲安慰剂对照随机对照试验的系统评价和荟萃分析。

IF 16.3 1区 医学 Q1 PSYCHIATRY Psychotherapy and Psychosomatics Pub Date : 2023-01-01 Epub Date: 2023-09-19 DOI:10.1159/000533494
Stefanie Kremer, Teresa Wiesinger, Tom Bschor, Christopher Baethge
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引用次数: 0

摘要

引言:社会功能(SF)是履行社会义务的能力,也是治疗的关键结果。目的:本研究旨在评估抗抑郁药对重度抑郁障碍(MDD)患者SF的影响。方法:本荟萃分析及其报告基于Cochrane Collaboration的《系统评价和荟萃分析手册》和PRISMA指南(在OSF注册)。我们系统地搜索了CENTRAL、Medline、PubMed CENTRAL和PsycINFO的双盲随机对照试验,比较了抗抑郁药和安慰剂,并报告了SF。我们计算了95%置信区间和预测区间的标准化平均差(SMD)。结果:我们从1188份筛查记录中选择了40份随机对照试验,其中16586名患者(平均年龄46.8岁,64.2%为女性)。在27项调查MDD(原发性抑郁症)患者的研究中,与安慰剂相比,抗抑郁药的SMD为0.25([95%CI:0.21;0.30]I2:39%)。在13项患有MDD合并身体状况或疾病的患者的试验中,总估计值为0.24([0.10;0.37]I2:75%)。在共病抑郁症中,具有高/不确定偏倚风险的研究的SMD高于低风险研究:0.29[0.13;0.44]对0.04[0.16;0.24];在原发性抑郁症中没有明显的这种作用。没有迹象表明报告存在相当大的偏见。SF疗效与抑郁评分的疗效相关,Spearman的rho 0.67(p<0.001)和QoL 0.63(p<001)。结论:抗抑郁药对SF的影响很小,与它对原发性MDD抑郁症状的影响相似,在共病抑郁症中值得怀疑。与抗抑郁和生活质量效应的强相关性表明领域之间存在重叠。
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Antidepressants and Social Functioning in Patients with Major Depressive Disorder: Systematic Review and Meta-Analysis of Double-Blind, Placebo-Controlled RCTs.

Introduction: Social functioning (SF) is the ability to fulfil one's social obligations and a key outcome in treatment.

Objective: The aim of the study was to estimate the effects of antidepressants on SF in patients with major depressive disorder (MDD).

Methods: This meta-analysis and its reporting are based on Cochrane Collaboration's Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF). We systematically searched CENTRAL, Medline, PubMed Central, and PsycINFO for double-blind RCTs comparing antidepressants with placebo and reporting on SF. We computed standardized mean differences (SMDs) with 95% CIs and prediction intervals.

Results: We selected 40 RCTs out of 1,188 records screened, including 16,586 patients (mean age 46.8 years, 64.2% women). In 27 studies investigating patients with MDD (primary depression), antidepressants resulted in a SMD of 0.25 compared to placebo ([95% CI: 0.21; 0.30] I2: 39%). In 13 trials with patients suffering from MDD comorbid with physical conditions or disorders, the summary estimate was 0.24 ([0.10; 0.37] I2: 75%). In comorbid depression, studies with high/uncertain risk of bias had higher SMDs than low-risk studies: 0.29 [0.13; 0.44] versus 0.04 [-0.16; 0.24]; no such effect was evident in primary depression. There was no indication of sizeable reporting bias. SF efficacy correlated with efficacy on depression scores, Spearman's rho 0.67 (p < 0.001), and QoL, 0.63 (p < 0.001).

Conclusions: The effect of antidepressants on SF is small, similar to its effect on depressive symptoms in primary MDD, and doubtful in comorbid depression. Strong correlations with both antidepressive and QoL effects suggest overlap among domains.

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来源期刊
Psychotherapy and Psychosomatics
Psychotherapy and Psychosomatics 医学-精神病学
CiteScore
29.40
自引率
6.10%
发文量
46
期刊介绍: Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.
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