Selective Serotonin Reuptake Inhibitors for the Treatment of Depression in Parkinson's Disease: A Systematic Review and Meta-Analysis.

IF 2.9 3区医学 Q2 PHARMACOLOGY & PHARMACY

Clinical Drug Investigation Pub Date : 2024-07-01 Epub Date: 2024-07-03 DOI:10.1007/s40261-024-01378-8

Renjie Gao, Panpan Zhao, Kai Yan

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Abstract

Background: Although selective serotonin reuptake inhibitors (SSRIs) are usually considered safe to use in patients with Parkinson's disease (PD), there are mixed data about their effectiveness, and only a few investigations have led to a total improvement of depressive symptoms in patients with PD.

Objectives: We aimed to conduct a comprehensive systematic review and meta-analysis of all studies that investigated the effectiveness of SSRIs in treating depression in the context of PD.

Methods: From its commencement to June 2024, the databases of MEDLINE via PubMed, Scopus, Embase, and Google Scholar were electronically searched for the relevant papers. All full-text journal articles assessing the effectiveness of SSRIs in treating depression in patients with PD were included. The tool developed by the Cochrane Collaboration was utilized to evaluate the bias risk. Data were analyzed utilizing a pair-wise comparison meta-analysis using the standardized mean difference.

Results: A total of 19 articles and 22 separate interventions were included. We found that SSRI treatment attenuated depression in patients with PD (1.242 standardized mean difference, 95% confidence interval 0.956, 1.529, p < 0.001). The general heterogeneity of the studies was medium (ϰ² = 72.818, T² = 0.317, df = 21, I² = 71.15%, p < 0.001). The funnel plot was reasonably symmetrical. However, three studies were trimmed to the left of the mean. Begg's test (p = 0.080), Egger's test (p = 0.121), and funnel plot showed no significant risk of publication bias. The meta-regression showed that the treatment effect increased as a function of paroxetine treatment duration (slope p = 0.001) but decreased as a function of sertraline treatment duration (slope p = 0.019).

Conclusions: There are few controlled antidepressant trials on the PD population, even though patients with PD frequently experience depression and use antidepressants. Clinical studies that are larger and better structured are needed in the future to determine if antidepressants are useful for treating patients with PD with depression.

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治疗帕金森病抑郁症的选择性羟色胺再摄取抑制剂：系统回顾与元分析》。

背景：尽管选择性5-羟色胺再摄取抑制剂（SSRIs）通常被认为在帕金森病（PD）患者中使用是安全的，但有关其疗效的数据却不尽相同，仅有少数研究表明帕金森病患者的抑郁症状得到了完全改善：我们旨在对所有调查SSRIs治疗帕金森病抑郁症有效性的研究进行全面的系统回顾和荟萃分析：从开始到2024年6月，通过PubMed、Scopus、Embase和Google Scholar的MEDLINE数据库对相关论文进行了电子检索。纳入了所有评估SSRIs治疗帕金森病患者抑郁症疗效的全文期刊文章。利用 Cochrane 协作组织开发的工具来评估偏倚风险。数据分析采用标准化均值差异的成对比较荟萃分析法：结果：共纳入了 19 篇文章和 22 项单独的干预措施。我们发现，SSRI治疗可减轻帕金森病患者的抑郁程度（标准化平均差为1.242，95%置信区间为0.956, 1.529，P < 0.001）。研究的总体异质性为中等（ϰ2 = 72.818，T2 = 0.317，df = 21，I2 = 71.15%，P < 0.001）。漏斗图具有合理的对称性。不过，有三项研究的结果偏左。Begg检验（P = 0.080）、Egger检验（P = 0.121）和漏斗图均显示没有明显的发表偏倚风险。元回归显示，治疗效果随帕罗西汀治疗时间的延长而增加（斜率 p = 0.001），但随舍曲林治疗时间的延长而减少（斜率 p = 0.019）：尽管帕金森氏症患者经常出现抑郁并使用抗抑郁药，但针对帕金森氏症患者的抗抑郁药对照试验却很少。未来需要开展规模更大、结构更合理的临床研究，以确定抗抑郁药是否有助于治疗伴有抑郁的帕金森病患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Drug Investigation 医学-药学

CiteScore

5.90

自引率

3.10%

发文量

108

审稿时长

6-12 weeks

期刊介绍： Clinical Drug Investigation provides rapid publication of original research covering all phases of clinical drug development and therapeutic use of drugs. The Journal includes: -Clinical trials, outcomes research, clinical pharmacoeconomic studies and pharmacoepidemiology studies with a strong link to optimum prescribing practice for a drug or group of drugs. -Clinical pharmacodynamic and clinical pharmacokinetic studies with a strong link to clinical practice. -Pharmacodynamic and pharmacokinetic studies in healthy volunteers in which significant implications for clinical prescribing are discussed. -Studies focusing on the application of drug delivery technology in healthcare. -Short communications and case study reports that meet the above criteria will also be considered. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Clinical Drug Investigation may be accompanied by plain language summaries to assist readers who have some knowledge, but non in-depth expertise in, the area to understand important medical advances.