Pharmacological and non-pharmacological treatments for major depressive disorder: review of systematic reviews.
Pharmacological and non-pharmacological treatments for major depressive disorder: review of systematic reviews.
复制标题
DOI：
10.1136/bmjopen-2016-014912
复制
发表时间：
2017-06-14
期刊：
影响因子：
2.9
通讯作者：
Lohr KN
中科院分区：
文献类型：
--
作者：
Gartlehner G;Wagner G;Matyas N;Titscher V;Greimel J;Lux L;Gaynes BN;Viswanathan M;Patel S;Lohr KN
这项研究旨在总结140多种治疗严重抑郁障碍(MDD)的药理学和非药理学治疗方案的证据，并评估患者和临床医生对其效果的基础科学的信心。这是对系统评价的回顾。这项研究使用了MEDLINE、Embase、Cochrane Library、CogcINFO和Eistemonikos，从2011年到2017年2月对成人MDD急性期患者的随机对照试验进行了系统评价。我们对摘要和全文进行了双重评价，对符合条件的系统性评价的偏倚风险进行了评级，并对证据的强度进行了评级。19项系统评价提供了28项兴趣比较的数据。就总体疗效而言，只有第二代抗抑郁药得到了强有力的证据支持，呈现出较小的有益治疗效果(标准化平均差异：−0.35；95%CI−0.31至−0.38)，因不良事件而停用的比率在统计学上显著高于服用安慰剂的患者(相对风险(RR)1.88；95% CI 1.0至3.2 8)。只有认知行为疗法得到可靠证据(中等证据强度)的支持，对治疗产生与第二代抗抑郁药相似的反应(45.5%对44.2%；RR 1.10；95% CI 0.93至1.3)。所有剩余的非药物治疗与第二代抗抑郁药的比较要么导致不确定的结果，要么存在重大的方法学缺陷(证据强度低或不足)。与药物治疗相比，治疗MDD患者的大多数非药物干预措施没有证据。对于强烈反对药物治疗的患者，临床医生应该把重点放在已经直接与抗抑郁药进行比较的治疗上。国际前瞻性系统评价登记册(PROSPERO)注册号：42016035580。
This study aims to summarise the evidence on more than 140 pharmacological and non-pharmacological treatment options for major depressive disorder (MDD) and to evaluate the confidence that patients and clinicians can have in the underlying science about their effects. This is a review of systematic reviews. This study used MEDLINE, Embase, Cochrane Library, PsycINFO and Epistemonikos from 2011 up to February 2017 for systematic reviews of randomised controlled trials in adult patients with acute-phase MDD. We dually reviewed abstracts and full-text articles, rated the risk of bias of eligible systematic reviews and graded the strength of evidence. Nineteen systematic reviews provided data on 28 comparisons of interest. For general efficacy, only second-generation antidepressants were supported with high strength evidence, presenting small beneficial treatment effects (standardised mean difference: −0.35; 95% CI −0.31 to −0.38), and a statistically significantly higher rate of discontinuation because of adverse events than patients on placebo (relative risk (RR) 1.88; 95% CI 1.0 to 3.28). Only cognitive behavioural therapy is supported by reliable evidence (moderate strength of evidence) to produce responses to treatment similar to those of second-generation antidepressants (45.5% vs 44.2%; RR 1.10; 95% CI 0.93 to 1.30). All remaining comparisons of non-pharmacological treatments with second-generation antidepressants either led to inconclusive results or had substantial methodological shortcomings (low or insufficient strength of evidence). In contrast to pharmacological treatments, the majority of non-pharmacological interventions for treating patients with MDD are not evidence based. For patients with strong preferences against pharmacological treatments, clinicians should focus on therapies that have been compared directly with antidepressants. International Prospective Register of Systematic Reviews (PROSPERO) registration number: 42016035580.
登录
查看更多内容
影响因子：
64.3
作者：
Furukawa, Toshi A.;Cipriani, Andrea;Salanti, Georgia
通讯作者：
Salanti, Georgia
影响因子：
7.2
作者：
Fe, Rongwei;Gartlehner, Gerald;Trikalinos, Thomas A.
通讯作者：
Trikalinos, Thomas A.
影响因子：
7.2
作者：
Berkman, Nancy D.;Lohr, Kathleen N.;Chang, Stephanie
通讯作者：
Chang, Stephanie
影响因子：
--
作者：
DiMatteo, MR;Lepper, HS;Croghan, TW
通讯作者：
Croghan, TW
影响因子：
7.8
作者：
Jobst, A.;Brakemeier, E. -L.;Padberg, F.
通讯作者：
Padberg, F.