The Effect of Antidepressants on Depression After Traumatic Brain Injury: A Meta-analysis.
The Effect of Antidepressants on Depression After Traumatic Brain Injury: A Meta-analysis.
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DOI：
10.1097/htr.0000000000000439
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Adeoye O
中科院分区：
文献类型：
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作者：
Kreitzer N;Ancona R;McCullumsmith C;Kurowski BG;Foreman B;Ngwenya LB;Adeoye O
创伤性脑损伤（TBI）后，抑郁症状很常见，可能会影响恢复。我们进行了一项荟萃分析，以评估TBI后抗抑郁药的获益，并比较抗抑郁药和安慰剂之间的估计效果。检索多个数据库，以寻找TBI后成人重度抑郁症（MDD）的前瞻性药物治疗研究。TBI患者抗抑郁药物的效应量计算为受试者内设计（检查接受药物治疗后较基线的变化）和治疗/安慰剂设计（检查抗抑郁药物组和安慰剂组之间的差异）。两项分析均采用随机效应模型。在筛选的1028个标题中，包括11个。合并估计值显示，药物和安慰剂之间的抑郁评分降低无显著差异（5项试验的标准化平均差异=-0.3; 95%CI，-0.6至0.0; I2 = 17%），药物治疗后个体的抑郁评分显著降低（汉密尔顿抑郁量表的平均变化= −11.2; 95%CI为−14.7至−7.6; I2 = 87%）。这项荟萃分析发现，在TBI后MDD的治疗中，抗抑郁药与安慰剂相比没有显著的益处。合并估计值显示出高度的偏倚和异质性。关于抗抑郁药在明确定义的TBI患者队列中的影响的前瞻性研究是必要的
Following traumatic brain injury (TBI), depressive symptoms are common and may influence recovery. We performed a meta-analysis to estimate the benefit of antidepressants following TBI and compare the estimated effects between antidepressants and placebo Multiple databases were searched to find prospective pharmacological treatment studies of major depressive disorder (MDD) in adults following TBI. Effect sizes for antidepressant medications in patients with TBI were calculated for within-subjects designs that examined change from baseline after receiving medical treatment and treatment/placebo designs that examined the differences between the antidepressants and placebo groups. A random-effects model was used for both analyses. Of 1028 titles screened, 11 were included. Pooled estimates showed nonsignificant difference in reduction of depression scores between medications and placebo (standardized mean difference of 5 trials = −0.3; 95% CI, −0.6 to 0.0; I2 = 17%), and a significant reduction in depression scores for individuals after pharmacotherapy (mean change = −11.2; 95% CI, −14.7 to −7.6 on the Hamilton Depression Scale; I2 = 87%). This meta-analysis found no significant benefit of antidepressant over placebo in the treatment of MDD following TBI. Pooled estimates showed a high degree of bias and heterogeneity. Prospective studies on the impact of antidepressants in well-defined cohorts of TBI patients are warranted