抗抑郁药物效应和抑郁症严重程度:一个患者层面的元分析
Jay C Fournier1, Robert J DeRubeis, Steven D Hollon
1Department of Psychology, University of Pennsylvania, 3720 Walnut St, Philadelphia, PA 19104, USA. jcf@sas.upenn.edu
JAMA
|January 7, 2010
概括
抗抑郁药的益处因抑郁症的严重程度而异. 对于轻度至中度抑郁症,药物治疗对安慰剂的优势很小. 然而,对于严重的抑郁症,抗抑郁药与安慰剂相比,显示出相当大的益处.
科学领域:
- 临床心理学 临床心理学
- 心理药理学 心理药理学
- 医学研究 医学研究
背景情况:
- 抗抑郁药物是主要治疗抑郁症的主要治疗方法.
- 在轻度抑郁症中比安慰剂具有特定药理效应的证据有限.
- 了解症状严重程度的治疗疗效对于临床实践至关重要.
研究的目的:
- 量化抗抑郁药物与安慰剂的比较有效性.
- 评估这种相对益处如何随着最初抑郁症症状严重程度的变化而变化.
- 为重大抑郁障碍的治疗指南提供信息.
主要方法:
- 在PubMed,PsycINFO和Cochrane图书馆 (1980-2009) 的系统文献搜索.
- 包括FDA批准的抗抑郁药的随机化安慰剂对照试验 (RCT).
- 用汉密尔顿抑郁症评分表 (HDRS) 来分析6项RCT (718名患者) 的个体患者级数据.
主要成果:
- 药物与安慰剂之间的差异强烈依赖于基线抑郁症严重程度.
- 对于患有HDRS得分低于23的患者,效应大小很小 (科恩d<0.20).
- 在25及以上的HDRS得分下观察到临床意义,这表明在更严重的病例中药物效益更大.
结论:
- 抗抑郁药对安慰剂的治疗益处随着抑郁症的严重程度而增加.
- 对于轻度至中度抑郁症,药物的优势可能是最小的或不存在的.
- 抗抑郁药对患有严重抑郁症的患者有很大的益处.
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