凯胺用于治疗严重抑郁症:系统性审查和元分析
Stevan Nikolin1,2, Anthony Rodgers3, Andreas Schwaab4
1Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia.
EClinicalMedicine
|August 18, 2023
概括
这次元分析发现,在抑郁症治疗中,racemic ketamine比esketamine更有效,更高的剂量显示出更大的疗效. 在治疗期间和最后一剂后,立即观察到效果.
科学领域:
- 神经科学是一个神经科学.
- 精神病学是一个精神病学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 鼻腔内注射的埃斯基坦胺已被批准用于治疗抑郁症.
- 最近的试验表明,赛血基胺在重度抑郁症中有效.
- 对于胺治疗的比较疗效,最佳剂量和反应时间仍不清楚.
研究的目的:
- 系统地审查和对抑郁症胺的随机对照试验 (RCT) 进行元分析.
- 为了比较racemic ketamine与esketamine的疗效.
- 为了研究剂量和治疗时间对胺有效性的影响.
主要方法:
- 在2023年4月13日之前对Embase,Medline,Pubmed,PsycINFO和CENTRAL数据库进行系统搜索.
- 包括49个RCT与3299名参与者,评估抑郁症的严重程度,反应,缓解和放弃.
- 超回归分析将药物配方 (racemic与esketamine) 和剂量 (低与高) 作为共同变量.
主要成果:
- 对于所有胺配方和剂量的第一剂后,抑郁症严重程度的影响大小为中度至高.
- 拉塞米克胺在重复服用期间和重复服用后,与胺相比,持续性和持久性效应显著增加.
- 较高剂量的胺与较低剂量的疗效相比,效果更大,在所有原因中断率上没有显著差异.
结论:
- 在治疗抑郁症方面, Racemic 胺似乎比 esketamine 更有效,特别是在更高剂量的情况下.
- 赛血基胺的好处超出了初始治疗的范围,显示了持续的效果.
- 进一步的研究应该专注于优化胺配方和剂量用于抑郁症治疗.
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