Efficacy of second generation antidepressants in late-life depression: A meta-analysis of the evidence
Efficacy of second generation antidepressants in late-life depression: A meta-analysis of the evidence
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DOI：
10.1097/jgp.0b013e3181693288
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发表时间：
2008-07-01
影响因子：
7.2
通讯作者：
Schneider, Lon S.
中科院分区：
文献类型：
--
作者：
Nelson, J. Craig;Delucchi, Kevin;Schneider, Lon S.
目的：第二代抗抑郁药是治疗老年抑郁症的常用药物。这项系统的综述和荟萃分析被用来评估第二代抗抑郁药对晚年重度抑郁症疗效的证据。方法：检索Cochrane图书馆(2006[3])、MEDLINE(1966-2006年8月)和会议报告，检索在美国上市的第二代抗抑郁药(非三环类)的试验。已发表和未发表的安慰剂对照随机临床试验针对60岁及以上患有非精神病性、单相严重抑郁症的门诊患者。提取临床特征和转归。结果用优势比(OR)、风险差异和加权平均差异来表示。结果：10个独特的试验(4个未发表)，13个对照符合选择标准。试验持续6-12周，包括2377名接受活性药物治疗的患者和1788名接受安慰剂治疗的患者。Meta分析显示，有效和缓解的OR值分别为1.4(95%可信区间为1.24~1.57，z=5.45，N=13，p<；0.001)和1.27(CI为1.12~1.44，z=3.67，N=13，p<；0.001)。抗抑郁药和安慰剂的平均汇集反应率分别为44.4%和34.7%。10~12周试验有效率(OR=1.73，CI 1.42~2.09，z=5.51，N=5，p<；0.001)显著高于6~8周试验(OR=1.22，CI 1.05~1.42，z=2.6，N=8，p=0.01)。因任何原因停药和不良事件的ORS，药物组显著高于安慰剂组。结论：在老年抑郁症受试者中，抗抑郁药比安慰剂更有效，尽管效果不明显且差异很大。确定应答者和无应答者的特征将是改善治疗结果的关键。
Objective: Second-generation antidepressants are commonly used to treat major depression in late-life. This systematic review and meta-analysis was undertaken to assess the evidence for efficacy of second-generation antidepressants in late-life major depression. Methods: The Cochrane Library (2006 [3]), MEDLINE (1966 to August 2006), and meeting presentations were searched for trials of second-generation antidepressants (nontricyclics) marketed in the United States. Published and unpublished placebo-controlled randomized clinical trials in outpatients 60 years and older, with nonpsychotic, unipolar major depression were selected. Clinical characteristics and outcomes were extracted. Outcomes were expressed as odds ratios (OR), risk differences, and weighted mean differences. Results: Ten unique trials (four unpublished) with 13 contrasts met selection criteria. Trials were 6-12 weeks duration, and included 2,377 patients who received active drug and 1,788 received placebo. The ORs by meta-analysis for response and remission were 1.40 (95% confidence interval [CI] 1.24-1.57, z = 5.45, N = 13, p < 0.001) and 1.27 (CI 1.12-1.44, z = 3.67, N = 13, p < 0.001), respectively, with significant heterogeneity for response and remission among the trials. Mean pooled response rates for antidepressant and placebo were 44.4% and 34.7%, respectively. The OR for response was significantly higher in the 10-12 week trials (OR = 1.73, CI 1.42-2.09, z = 5.51, N = 5, p < 0.001) than the 6-8 week trials (OR = 1.22, CI 1.05-1.42, z = 2.60, N = 8, p = 0.01). ORs for discontinuation for any reason and for adverse events were significantly higher with drugs than with placebo. Conclusions: Antidepressants are more effective than placebo in elderly depressed subjects although effects are modest and vary. Identification of the characteristics of responders and nonresponders will be crucial to improving treatment outcomes.